Baila Elkin, MD1, Joseph El Dahdah, MD1, Qijun Yang, MS1, Yueqi (Renee) Wu, MPH2, C Roberto Simon-Linares, MD1, Carol Rouphael, MD3 1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Lerner Research Institute, Cleveland Heights, OH; 3Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
Introduction: There is no clear guidance on diagnostic endoscopy (EGD) pre-bariatric surgery, and US guidelines recommend an individualized approach. Research indicates a relatively high incidence of upper gastrointestinal pathology detected on pre-operative EGD which could impact surgical planning.
We explore the incidence of gastric pathology found on surgical specimens from sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) and evaluate for missed pre-operative diagnostic opportunities.
Methods: This retrospective study included patients ≥18 years old who underwent RYGB or SG between 01/2018 and 01/2022 at a tertiary care center and had a surgical specimen submitted. Exclusions were history of gastric cancer or hereditary cancer syndromes. Structured query language and natural language processing were used for patient identification and data collection. Patient characteristics including sex, race, ethnicity, surgery type, pre-operative EGD and findings, and findings on surgical specimens were collected. Descriptive statistics were used.
Results: Among the 3718 patients who underwent RYGB or SG within the study period, 2349 patients had surgical specimens submitted to pathology (96.8% from SG and 3.24% from RYGB) and were included (Table). 78.8% were female, 66% white, and 15.4% Hispanic. Median age was 46.2 years [interquartile range (IQR) 36.4; 55.7], and body mass index was 44.0 kg/m2 (IQR 40.1; 49.0) at surgery. 3.7% of patients had a family history of gastric cancer. Regarding gastric pathology, 24 (1.02%) had gastric intestinal metaplasia (GIM) on surgical specimens, 92 (3.92%) had Helicobacter Pylori (HP), 8 (0.34%) had gastric atrophy and 2 (0.085%) had mucosa-associated lymphoid tissue (MALT) lymphoma. No surgical specimens had dysplasia or adenocarcinoma. 10 of the patients with GIM on surgical pathology had pre-surgical EGD, and only 4 had gastric biopsies. 32 of the patients with HP on surgical pathology had pre-surgical EGD, and only 18 had biopsies. Those with MALT lymphoma on surgical specimens had no pre-operative EGD.
Discussion: Gastric pathology including GIM, HP and MALT lymphoma was detected on 5% of surgical specimens. There were missed opportunities for pre-operative detection of gastric pathology via EGD with gastric biopsy in 81% of those with gastric pathology on surgical specimens. This highlights the importance of pre-bariatric EGD with gastric biopsies. Additional studies are needed to determine the clinical and cost-effectiveness of EGD pre-bariatric surgery.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Baila Elkin indicated no relevant financial relationships.
Joseph El Dahdah indicated no relevant financial relationships.
Qijun Yang indicated no relevant financial relationships.
Yueqi (Renee) Wu indicated no relevant financial relationships.
C Roberto Simon-Linares indicated no relevant financial relationships.
Carol Rouphael indicated no relevant financial relationships.
Baila Elkin, MD1, Joseph El Dahdah, MD1, Qijun Yang, MS1, Yueqi (Renee) Wu, MPH2, C Roberto Simon-Linares, MD1, Carol Rouphael, MD3. P5053 - An Assessment of Missed Opportunities in Diagnosing Gastric Pathology Pre-Bariatric Surgery, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
