Endoscopy Prior To And After Bariatric Surgery

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) have produced an important position statement on the role of endoscopy prior to, as well as after bariatric surgery. This paper was published in 2019, in Obesity Surgery, and attempts to rationalise the role of endoscopy for these patients.

I was fortunate to be a part of this paper, and believe that it is an important tool for clinicians that deal with bariatric surgery patients around the world.

Research into the long-term results of bariatric surgery is continuing to evolve, and it is important that patients be seen by a medical practitioner, who can discuss their specific situation.

The findings of the paper can be summarised as:

1. Gastroscopy be considered for all patients with upper GI symptoms planning to undergo a bariatric procedure due to the frequency of pathology that may alter management.
2. Gastroscopy be considered for patients without upper GI symptoms who are planning to undergo a bariatric procedure due to the 25.3% chance of an unexpected finding that may alter management or contra-indicate surgery.
3. Gastroscopy should be routinely considered in populations where the community incidence of significant gastric and esophageal pathology is high, particularly when the procedure will lead to part of the stomach being inaccessible (for example RYGB and OAGB).
4. Gastroscopy be undertaken routinely for all patients after bariatric surgery at one year and then every 2-3 years for patients who have undergone LSG or OAGB to enable early detection of Barrett’s Esophagus or upper GI malignancy until more data is available to confirm the incidence of these cancers in practice.
5. Gastroscopy be performed following AGB and RYGB on the basis of upper GI symptoms

These recommendations were created based on the information we currently have, and will continue to evolve with further evidence.

Dr Balalis is a GESA accredited endoscopist, who is experienced in assessing bariatric patients. He is conducting gastroscopies for patients that require assessment, and is also available for consultations.

For more information, do not hesitate to contact Dr Balalis.