Prevalence of gastric intestinal metaplasia and other endoscopic findings and their influence on surgical management for patients seeking bariatric surgery.

Abstract

Background: Routine preoperative esophagogastroduodenoscopy (EGD) for patients undergoing bariatric surgery remains controversial. However, anatomopathologic findings during endoscopy can influence the choice of bariatric procedure. Gastric intestinal metaplasia (GIM) is increasingly recognized as a potential risk factor for gastric adenocarcinoma, with a prevalence of 2.7% in patients seeking bariatric surgery.

Objective: To establish the prevalence of GIM among patients undergoing bariatric surgery in our population and determine the impact of routine EGD on surgical management.

Setting: Canadian academic hospital.

Methods: We retrospectively reviewed the charts of 314 consecutive patients who underwent routine EGD with antral/corpus biopsies by a single endoscopist at our institution between March 2021 and November 2022. Data were collected on patient demographic characteristics and EGD and pathology reports.

Results: The population consisted of 234 (74.5%) female patients and 80 (25.5%) male patients with average age of 43.6 years and body mass index of 46.5 kg/m². GIM was present in 8.6% of endoscopies, high-risk GIM in 2.9%, and Helicobacter pylori in 16.6%. Esophagitis and Barrett esophagus (BE) were present in 19.4% and 1.6% of patients, respectively. Regression analysis independently associated previous H pylori infection, antral erosive gastritis, BE, and mucosal atrophy with GIM. Preoperative EGD altered surgical management for 14.3% of patients. Reasons for alteration included hiatal anatomy (9.6%), GIM (2.2%), BE (.6%), gastric and esophageal varices (.6%), achalasia (.3%), and gastric adenocarcinoma (.3%).

Conclusion: We demonstrated greater GIM and high-risk GIM prevalence than previously published in the literature. GIM is the second most frequent finding altering surgical decision making in our bariatric population.