Clinical Relevance of Preoperative Upper Gastrointestinal Endoscopy before Sleeve Gastrectomy: A Retrospective Cohort Study of 30-Day Outcomes.

Abstract

Background: Routine preoperative upper gastrointestinal endoscopy before sleeve gastrectomy remains debated. This study evaluated whether selected endoscopic and histopathologic findings were associated with 30-day outcomes after sleeve gastrectomy, with specific attention to reflux-related events and severity-stratified staple-line leak.

Methods: We retrospectively analyzed 315 adults who underwent laparoscopic sleeve gastrectomy at a tertiary referral center between June 2016 and December 2019. All patients underwent preoperative esophagogastroduodenoscopy with Sydney-protocol biopsies. Postoperative outcomes were assessed within 30 days. The leak was classified as limited/minimal when managed with antibiotics alone and as major when invasive intervention or death occurred.

Results: Postoperative reflux symptoms occurred in 47 patients (14.9%). Staple-line leak was diagnosed in 13 patients (4.1%) after oral intake using clinical findings, inflammatory markers, and contrast-enhanced computed tomography; routine postoperative day 1 upper gastrointestinal contrast passage studies were normal in all leak patients. Ten leaks were limited/minimal and resolved with antibiotics alone, whereas 3 patients (0.95%) had major leaks requiring percutaneous/endoscopic or surgical intervention. Hiatal hernia was associated with postoperative reflux symptoms, and previous upper abdominal surgery was associated with leak. Associations involving endoscopic bile reflux/possible pyloric dysfunction were exploratory because objective motility testing was unavailable.

Conclusions: Preoperative endoscopy may identify selected foregut abnormalities relevant to early outcomes after sleeve gastrectomy, particularly reflux-related anatomy. Leak-related findings should be interpreted cautiously because event numbers were small; severity-stratified reporting provides a more clinically meaningful interpretation than an undifferentiated leak rate.