Preoperative endoscopies remain a common practice performed by most bariatric surgeons, however there is no conclusive evidence to support this practice.
A retrospective review of patients who underwent sleeve gastrectomy between July 2016 and June 2021 was performed. Correlation between endoscopic and surgical pathology findings were assessed. Cox regression was performed to study the association between risk factors and surgical pathology findings.
A total of 224 patients were included, of which 83 (37%) were found to have a positive surgical pathology. Gastritis was identified in 169 endoscopies, yet there were only seen in 55 pathology reports (37.9% concordance). Hiatal hernias were identified in 86 endoscopies, but described in only 29 surgery reports (37% concordance). A concordance rate >90% was identified for gastric polyps, gastric varices, ulcers, and gastric neoplasms. Male sex (p=0.041) and median age at surgery (p=<0.001) were the only risk factors significantly associated with positive pathology results. Prevalence Rate for male sex and median age at surgery was 1.40 (p=0.141; 95% CI 0.89-2.18) and 1.03 (p=0.012; 95% CI 1.01-1.05), respectively. Thus, there was a 3% positive association per year between age at surgery and positive pathology findings.
There is an increased prevalence of pathologic findings with increasing age for patients who undergo sleeve gastrectomy within this population. Preoperative endoscopies yield an overestimated positive result for gastritis and hiatal hernias.