Currently, esophagogastroduodenoscopy (EGD) is recommended for symptomatic patients prior to laparoscopic Roux-en-Y gastric bypass (LRYGB), but the use of EGD for routine screening in asymptomatic patients is debatable. We aimed to study the utility of routine EGD in patients undergoing LRYGB.

A retrospective review of consecutive patients undergoing LRYGB with one surgeon at our hospital from May 2014 to March 2016 was completed. Data for these participants were collected using from patient clinical records. All patients had preoperative EGD with biopsies. EGD findings were compared with findings from surgical gastrojejunal (GJ) anastomoses pathology and postoperative complications.

116 patients were identified with an average age of 46.2 ± 10.3 years and 70.7% were female. Of the 113 patients with reported EGDs, 52 patients (46.0%) had normal EGD, 46 (40.7%) had at least one EGD pathology but did not result in change of management, and 15 (13.3%) had EGD pathologies resulting in change of management. Sixteen patients (13.8%) were found to have chronic gastritis of the GJ anastomosis. The relative risk of patients with gastritis in the GJ specimen was 5.1 (p < 0.001) for patients with gastritis on EGD, and also 5.1 (p < 0.001) for patients with HP on EGD. Seventeen patients (14.7%) had complications following surgery, eleven of which had marginal ulcers. The relative risk of patients with marginal ulcers was 1.1 (p = 0.84) for patients with gastritis on EGD, and 1.9 (p = 0.38) for patients with HP on EGD. No anastomotic leaks were identified.  

Routine EGD only identified abnormalities leading to change in management in 13.3% of patients, and abnormalities on EGD did not significantly associate with postoperative complications. Based on the findings from this study, we recommend using less invasive screening in the routine workup of patients awaiting LRYGB, and reserving EGD for symptomatic patients.

The Utility of Routine Esophagogastroduodenoscopy Prior to Laparoscopic Roux-en-Y Gastric Bypass