Preoperative Upper Endoscopy and Surgical Specimen Findings in Bariatric Surgery Patients

Background: The role of routine esophagogastroduodenoscopy (EGD) before metabolic bariatric surgery (MBS) remains unclear. We examined which patients were more likely to undergo preoperative EGD with biopsies, assessed the prevalence of clinically significant gastric pathologies on surgical specimens that may have been missed preoperatively, and analyzed patient factors associated with those findings. Methods: Patients ≥ 18 years old with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2018 and 2022 were included. Demographic, clinical, endoscopic, and pathology (from EGD and surgical specimens) characteristics were collected. Descriptive statistics were used. Uni- and multivariable Cox regression analyses assessed factors associated with clinically significant endoscopic and pathology findings. Results: Of 3718 patients (38.8% RYGB, 61.2% SG), 80% were female, 69.9% White, and 12.6% Hispanic. Median age at surgery was 45.7 years; median body mass index was 44.5 kg/m². Preoperative EGD was performed in 36.9% of patients. Surgical specimens were available for 2349 patients (2273 SG and 76 RYGB), among whom 135 had clinically significant pathology. 63.7% of these patients had no preoperative EGD, 15.6% had preoperative EGD without biopsies, and 20.7% preoperative EGD with biopsies. Older age and non-White, non-Black race were associated with clinically significant findings on EGD or pathology. Conclusions: Several clinically relevant gastric pathologies could have been detected preoperatively via EGD with biopsies, yet about two-thirds did not undergo this evaluation. Older age and non-White, non-Black race were associated with these findings. Further research is needed to assess predictive factors of significant findings and cost-effectiveness of routine versus selective pre-operative EGD.