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Preoperative Endoscopic Findings in Veterans Undergoing Bariatric Surgery: Prevalence and Predictors of Barrett’s Esophagus

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Abstract

Introduction

There is no consensus regarding the need for routine esophagogastroduodenoscopy (EGD) in patients before bariatric surgery. The aim of our study is to determine the frequency and predictors of EGD findings in a Veteran population presenting for bariatric surgery.

Methods

This is a single-center retrospective analysis of Veterans who underwent RYGB or LSG, at a Veterans Affairs hospital between January 2008 and December 2017. All patients received a preoperative EGD. Data abstracted included demographics, comorbidities, preoperative laboratory values, and EGD findings. Univariate and multivariate analyses were performed for common EGD pathologies.

Results

Of the 260 Veterans included in our cohort, majority were male (75.0%), Caucasian (73.5%), and aged 54.0 ± 9.0 years old with a BMI of 44.9 ± 7.0 kg/m2. Most had hypertension (78.9%), previously smoked (63.9%), and recently used a proton pump inhibitor (PPI) (53.1%). One third of Veterans had a completely normal preoperative EGD. Common preoperative EGD findings included gastritis (35.8%), hiatal hernia (25.8%), esophagitis (20.8%), duodenitis (10.4%), Barrett’s esophagus (7.4%), and Helicobacter pylori infection (4.6%). Preoperative predictors for a normal EGD were female gender, absence of hypertension, and no recent PPI use. Preoperative predictors of Barrett’s esophagus included older age, recent PPI use, and recent histamine H2 receptor blocker (H2B) use. Increased age, male gender, and PPI use were associated with a change in surgical and/or medical management.

Conclusion

Preoperative factors can be used to identify patients at risk for gastroesophageal pathology. Our data support preoperative EGD especially in older males with a history of PPI or H2B use.

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Authors and Affiliations

  1. Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, 94305, USA

    Katharine A. Ozeki

  2. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, 94305, USA

    Sally A. Tran & Ramsey Cheung

  3. Division of Gastroenterology and Hepatology (111GI), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, 94304, USA

    Ramsey Cheung

  4. Surgical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA

    Dan Eisenberg

  5. Department of Surgery – General Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA

    Dan Eisenberg

Authors
  1. Katharine A. Ozeki
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  2. Sally A. Tran
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  3. Ramsey Cheung
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  4. Dan Eisenberg
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Corresponding author

Correspondence to Ramsey Cheung.

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Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Stanford University and Palo Alto Veterans Association Health Care Systems institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Ozeki, K.A., Tran, S.A., Cheung, R. et al. Preoperative Endoscopic Findings in Veterans Undergoing Bariatric Surgery: Prevalence and Predictors of Barrett’s Esophagus. OBES SURG 30, 657–663 (2020). https://doi.org/10.1007/s11695-019-04234-3

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  • DOI: https://doi.org/10.1007/s11695-019-04234-3

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