Is Elective Gastroscopy Prior to Bariatric Surgery in an Asian Cohort Worthwhile?

Background: The preoperative use of gastroscopy for patients undergoing bariatric surgery remains controversial. We aim to evaluate the diagnostic yield of gastroscopy and the clinical significance in asymptomatic individuals undergoing bariatric surgery in Asia.

Methods: We retrospectively reviewed the medical records of all patients undergoing gastroscopy prior to bariatric surgery at the National University Hospital and Khoo Teck Puat Hospital, Singapore, between Jan 2006 and June 2013. Gastroscopy findings were classified into four groups: group 1 (normal study), group 2 (abnormal findings that do not modify surgical approach), group 3 (abnormal findings that modify surgical approach) and group 4 (absolute contraindications to immediate surgery).

Results: During the study period, 208 asymptomatic individuals were evaluated by gastroscopy prior to bariatric surgery. Gastroscopy was normal in 70 (33.6 %). Group 2 comprised 67 (32.2 %) patients with mild gastritis or oesophagitis. Group 3 included 69 (33.2 %) patients diagnosed with erosive gastritis or oesophagitis, peptic ulcer disease, hiatal hernia or mass lesions. There were 2 patients (1.0 %) in group 4. One patient had a gastro-oesophageal junction adenocarcinoma, and 1 had a gastrointestinal stroma tumour. In group 3, modification of surgical approach included concurrent hiatal hernia repair, institution of medical therapy with delay in surgery, further evaluation of mass lesions and change in choice of surgical procedures.

Conclusions: Routine gastroscopy for asymptomatic bariatric patients has a high diagnostic yield. Given the high percentage of patients with clinically important lesions, our current experience supports the use of routine preoperative gastroscopy prior to bariatric surgery in Singapore.