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PMO-198 Post-operative endoscopy in bariatric surgery patients

Introduction Bariatric surgical patients may require endoscopy in the post-operative phase. The current study analyses the indications and findings of upper GI endoscopy (OGD) in post-operative bariatric surgery patients. Methods A retrospective analysis of all bariatric surgery patients referred for oesophagogastroduodenoscopies (OGDs) at Charing Cross Hospital from 1 January 2009 to 30 October 2011. The Endoscopy units' electronic database of OGDs performed was analysed to determine how many bariatric surgery patients had OGDs post-operatively. Further sub-analysis was done for each operation type. Results During this time period 1093 bariatric surgeries were performed. These included 542 laparoscopic gastric bypasses, 220 laparoscopic gastric bands, 223 laparoscopic sleeve gastrectomies and 108 revisional bariatric procedures. 147 OGDs were performed on a total of 116 Bariatric surgical patients, with 23 patients having had more than one OGD. Of these 147, 103 were done post-operatively; 58 (56.3%) post-roux-en-y gastric bypass, 34 (33%) post-gastric band insertion, 6 (5.8%) post-gastric sleeve gastrectomy and 5 (4.9%) post- bariatric revisional surgery. Indications for OGDs were abdominal pain (44.7%), vomiting (15.5%), haematemesis/malaena (9.7%), failure of weight loss (7.8%), follow-up for previous scopes/imaging (6.8%), reflux symptoms (3.9%), dysphagia (3.9%), interventional purposes (3 naso-jejunal tube insertions and 1 stricture dilatation) (3.9%), suspected abnormal positioning/band erosion (2.9%) and microcytic anaemia (0.9%). Of the 34 gastric band OGDs done 13 were normal and 21 showed abnormalities including 7 gastric band erosions, 6 with mucosal inflammation, 2 with insufficient band compression, 2 with abnormal band position and 2 hiatal hernias. Of the 58 post-bypass endoscopies done 33 were normal, 15 showed anastomotic/pouch ulceration/inflammation/erosion, 4 showed signs of recent haemorrhage and 3 oesophageal irritation. Out of 6 post-sleeve OGDs 2 were normal, 1 was done for an interventional stricture dilatation, 1 showed a gastric stricture, 1 oesophageal candidiasis and 1 a hiatal hernia. Four OGDs out of 5 done post-revisional surgery were normal. Of all OGDs referred for post-operative abdominal pain, 50% yielded abnormal findings. Conclusion Endoscopy units need to be familiar with and prepared for bariatric surgery patients as post-operatively a substantial number will need endoscopic postoperative assessments. In our study 9.4% of all postoperative bariatric surgery patients underwent endoscopy, the commonest referral reason was abdominal pain and the commonest finding was normal. Competing interests None declared.