International Federation for Surgery for Obesity and Metabolic Disorders Position Statement on the role of Upper Gastrointestinal Endoscopy Before and After Metabolic Bariatric Surgery.

Background: The International Federation for Surgery for Obesity and Metabolic Diseases (IFSO) provides Position Statements to assist clinical decision making. The use of upper gastrointestinal endoscopy (UGIE) before and after MBS is a topic of debate in clinical practice. This Position Statement updates two previous Position Statements on this issue.

Methods: A taskforce undertook a systematic review of available literature according to PRISMA guidelines. Critical appraisal of the methodology of each paper was performed according to the Joanna Briggs Institute. Recommendations based on the derived data were generated and then approved by the Scientific Committee of IFSO.

Results: The rate of abnormal findings on pre-MBS UGIE was 61% (95% CI 55%-67%; I² 98.99%). However, less than 1% (I² 58.39%) of people undergoing a pre-MBS UGIE were found to have a condition that precluded MBS; although, 35% either needed treatment for their condition and in 23% there was a Change of the planned MBS procedure type. Despite the frequency of abnormal pathology on pre-MBS UGIE, symptoms were a poor predictor of abnormal findings. The post-operative incidence of BE after MBS was estimated at 2.4% (95% CI 1.66-3.45; I² = 92.1%). The rates of both regression and progression of known BE present prior to MBS were poorly defined.

Conclusions: Noting the heterogenous nature of the data, high likelihood of bias, variability of definitions of UGIE detected pathology and Limited follow-up beyond 2 years, seven recommendations for clinical practice are provided, with a caveat that the data should be re-explored in 3 years.