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

Colman, Ruben J.*; Baidal, Jennifer A. Woo; Zitsman, Jeffrey L.; Mencin, Ali A.

Journal of Pediatric Gastroenterology and Nutrition: May 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002371
Original Article: Gastroenterology: PDF Only
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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.

*Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, NY

Division of Pediatric Surgery, Columbia University Irving Medical Center, New York, NY.

Address correspondence and reprint requests to Ruben J. Colman, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2010, 45229, Cincinnati, OH (e-mail: ruben.colman@cchmc.org).

Received 10 January, 2019

Accepted 7 April, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Conflict of interest disclosure RJC, JWB, JLZ and AAM have nothing to disclose.

Funding sources none

Author Contributions: RJC - Conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content.

JWB, AAM - Conception and design; interpretation of the data; drafting of the article; critical revision of the article for important intellectual content.

JLZ - Interpretation of the data; drafting of the article; critical revision of the article for important intellectual content.

All authors approved the final article.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,