Upper gastrointestinal tract involvement in the management of bariatric patients in the Kingdom of Saudi Arabia

Georgios Zacharakis; Abdulaziz Almasoud; Jamaan AlZahrani; Sameer Al-Ghamdi; Abdullah Altuwaim; Abdullah AlShehri; Abdullah Bawazir; Ahmad Alonazi; Faisal Alsamari; Mohammed Alajmi; Ahmed Lotfy; Pavlos Nikolaidis; Alexandros Kyritsis; Ioannis Terzis

Authors Georgios Zacharakis, Abdulaziz Almasoud, Jamaan AlZahrani, Sameer Al-Ghamdi, Abdullah Altuwaim, Abdullah AlShehri, Abdullah Bawazir, Ahmad Alonazi, Faisal Alsamari, Mohammed Alajmi, Ahmed Lotfy, Pavlos Nikolaidis, Alexandros Kyritsis, Ioannis Terzis.

Abstract

Background Preoperative esophagogastroduodenoscopy (EGD) may affect the management of bariatric patients although this is not consistent universally. The present prospective study evaluated the effect of preoperative EGD findings in obese Saudi patients, including upper digestive symptoms (UDS) and comorbidities, on their planned surgery.

Methods From January 2018 to May 2019, we conducted a 4-center retrospective observational study to evaluate the endoscopic findings among Saudi patients aged 18-65 years with a body mass index (BMI) >40 kg/m2. Preoperative data included UDS, comorbidities, Helicobacter pylori (H. pylori) infection assessed during a histopathological examination, and EGD findings.

Results 717 patients underwent EGDs, and 432 underwent bariatric surgery. The mean BMI was 44.3±6.3 kg/m2, and the mean age was 27.8±11.8 years. The overall UDS prevalence was 49%, with the most frequent being gastroesophageal reflux disease 54% (387/717), followed by dyspepsia 44% (315/717). H. pylori infection was detected in 287/672 (42.4%) patients. The total percentage of patients with normal EGD was 36% (258/717). A delayed bariatric procedure was performed in 15% of the patients for the following reasons: 2.3% had large
polyps of >1 cm (either hyperplastic or cystic polyps); 1.62% had esophagitis grade C and D based on the Los Angeles classification; 0.7% had Barrett’s esophagus; and 5.7% had peptic ulcer disease.

Conclusions Our findings confirmed that obesity carries a profound health burden with a significant impact on health expenditures. Routine preoperative EGD in the obese Saudi population appears to be mandatory to identify factors that may change, delay, or postpone the bariatric procedure.

Keywords Bariatric surgery, morbid obesity, Helicobacter pylori, endoscopic findings, delayed or postponed surgery

Ann Gastroenterol 2021; 34 (2): 177-182