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GERD-screening before bariatric surgery: the predictive value of the GERD-HRQL questionnaire score compared with preoperative EGD findings

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

There is an ongoing debate on how to best identify patients with gastroesophageal reflux disease (GERD) before bariatric surgery. The value of routine preoperative esophagogastroduodenoscopy (EGD) is questioned, and patient reported symptoms are commonly used for screening. The goal of this study is to determine if patient reported symptoms using a validated questionnaire correlate with preoperative EGD findings.

Methodology

A prospective cohort study at a single institution was performed. Patients undergoing bariatric surgery between December 2020 and March 2023 were required to report symptoms of reflux by completing a preoperative GERD. Health-Related Quality of Life (GERD-HRQL) questionnaire and undergo a mandatory preoperative screening EGD. Patients were stratified into two cohorts: (group A) asymptomatic (score = 0) and (group B) symptomatic (score > 0). Statistical analysis was conducted using Pearson’s chi-squared test and Wilcoxon rank-sum test in RStudio version 4.2.2. The predictive value of the GERD-HRQL score was analyzed using Areas Under the Curve (AUC; AUC = 0.5 not predictive, 0.5 < AUC ≥ 6 poor prediction & AUC > 0.9 excellent prediction) calculated from Receiver Operating Characteristic (ROC) curves.

Results

200 patients were included; median age was 42.0 years (IQR 36.0 to 49.2). There were 79 patients (39.5%) in Group A and 121 patients (60.5%) in Group B. There was no difference in the frequency esophagitis (27.8% vs 32.2%, p = 0.61) or hiatal hernias (49.4% vs 47.1%, p = 0. 867) between group A and group B, respectively. ROC analysis revealed that the total GERD HRQL scores, heartburn only scores and regurgitation only scores, were poor predictors of esophagitis found on EGD (AUC 0.52, 0.53, 0.52), respectively. In asymptomatic patients, higher BMI was significantly associated with esophagitis (OR 1.15, 95% CI 1.06–1.27, p = 0.002).

Conclusion

Symptoms, identified through the GERD-HRQL questionnaire, are a poor indicator of esophagitis or its severity in patients undergoing workup for bariatric surgery. Therefore, liberal screening upper endoscopy is recommended for pre-bariatric surgery patients to guide appropriate procedure selection.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA

    Jonathan Allotey, Michael Caposole, Abdallah Attia, Erin Coonan, Valeria Noguera, Emma Lewis, Molly S. Bloomenthal, Mahmoud Omar, Benjamin Crisp, John Baker, Shauna Levy & Carlos Galvani

  2. Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA

    Peter Issa

  3. Division of Otolaryngology- Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Mohamed Aboueisha

  4. Division of Minimally Invasive Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA

    Carlos Galvani

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  1. Jonathan Allotey
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  2. Michael Caposole
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Correspondence to Carlos Galvani.

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Disclosure

Jonathan Allotey, Abdallah Attia, Michael Z. Caposole, Erin E. Coonan, Valeria Noguera, Emma Lewis, Molly S. Bloomenthal, Peter Issa, Mahmoud Omar, Mohamed Aboueisha, Benjamin G. Crisp, John W. Baker, Shauna Levy, Carlos A. Galvani. Intuitive Surgical; Honoraria; Speaking/Teaching. Covidien; Honoraria; Speaking/Teaching. WL Gore; Honoraria; Speaking/Teaching have no conflicts of interest or financial ties to disclose.

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This research was presented at SAGES 2023 Annual Meeting - SS39: Bariatric Session II – S246; “Screening for GERD In Bariatric Surgery: The Predictive Value of the GERD-HRQL Questionnaire Score Compared with Preoperative EGD.” April 1, 2023. Montréal, QC Canada.

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Allotey, J., Caposole, M., Attia, A. et al. GERD-screening before bariatric surgery: the predictive value of the GERD-HRQL questionnaire score compared with preoperative EGD findings. Surg Endosc 37, 9572–9581 (2023). https://doi.org/10.1007/s00464-023-10388-0

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  • DOI: https://doi.org/10.1007/s00464-023-10388-0

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