Upper GI Endoscopy in Adolescents with Severe Obesity Prior to Vertical Sleeve Gastrectomy.

Abstract

OBJECTIVES Esophagogastroduodenoscopy (EGD) is often performed to evaluate for mucosal and anatomical abnormalities prior to vertical sleeve gastrectomy (SG). However, little is known about how pre-bariatric EGD in adolescents influences clinical management or outcome. Our aim was to assess if an abnormal pre-bariatric EGD resulted in interventions or modification of bariatric surgery. METHODS We performed a retrospective cohort study of adolescents undergoing evaluation for bariatric surgery. We obtained demographic and anthropometric data in addition to EGD findings, biopsy pathology, gastrointestinal symptoms and surgical outcomes. An EGD was considered abnormal if either abnormal gross findings or abnormal pathology was reported. Patients were followed until a 6-week post-op visit. RESULTS Of 134 patients presenting for evaluation, 94 (70%) underwent pre-operative EGD. Fifty-one (54%) had a normal EGD and 43 (46%) had EGD abnormalities including 7 with an anatomical abnormality and 36 with mild mucosal abnormalities. Among patients with EGD abnormalities 22% received medical intervention including proton pump inhibitors (PPI) administration (n = 10) and H. pylori eradication (n = 11). GI symptoms were the only predictor of EGD abnormalities (odds ratio (OR) 4.9: 95% CI, 1.6-15.0; p < 0.001). No factors predicted likelihood of a post-EGD intervention. An abnormal EGD did not correlate with any post-operative complications. CONCLUSIONS In this cohort of adolescents undergoing evaluation for SG, 46% had an abnormal EGD, of which 22% received a medical intervention. Symptoms were the only predictor of EGD abnormalities. Abnormal EGD findings were not associated with modification of the surgery or any adverse outcome.