Indications for upper gastrointestinal endoscopy before bariatric surgery: a multicenter study.

BACKGROUND: The role of preoperative upper gastrointestinal endoscopy before bariatric surgery is still debated, and a consensus among the international scientific community is lacking. The aims of this study, conducted in three different geographic areas, were to analyze data regarding the pathological endoscopic findings and report their impact on the decision-making process and surgical management, in terms of delay in surgical operation, modification of the intended bariatric procedure, or contraindication to surgery. METHODS: This is a multicenter cross-sectional study using data obtained from three prospective databases. The preoperative endoscopic reports, patient demographics, Body Mass Index, type of surgery, and Helicobacter pylori status were collected. Endoscopic findings were categorized into four groups: (1) normal endoscopy, (2) abnormal findings not requiring a change in the surgical approach, (3) clinically important lesions that required a change in surgical management or further investigations or therapy prior to surgery, and (4) findings that contraindicated surgery. RESULTS: Between 2006 and 2020, data on 643 patients were analyzed. In all of the enrolled bariatric institutions, preoperative endoscopy was performed routinely. A total of 76.2% patients had normal and/or abnormal findings that did not required a change in surgical management; in 23.8% cases a change or a delay in surgical approach occurred. Helicobacter pylori infection was detected in 15.2% patients. No patient had an endoscopic finding contraindicating surgery. CONCLUSIONS: The role of preoperative UGE is to identify a wide range of pathological findings in patients with obesity that could influence the therapeutic approach, including the choice of the proper bariatric procedure. Considering the anatomical modifications, the incidence of asymptomatic pathologies, and the risk of malignancy, we support the decision of performing preoperative endoscopy for all patients eligible for bariatric operation.

Endoscopic Resection of Upper Gastrointestinal Subepithelial Tumours: Our Clinical Experience and Results.

Upper gastrointestinal subepithelial tumours (SETs) are generally asymptomatic and clinically insignificant and have malign, borderline and benign variants. In advanced endoscopic procedures, histopathological diagnosis and endoscopic resection are possible and feasible. In this study, we examined our approach to upper gastrointestinal subepithelial tumours and our clinical results. Adult patients who applied to Surgical Endoscopy unit between January 2014 and January 2015 were included in the study. The patients' files and final histopathological diagnoses were recorded and analysed retrospectively for this single-center study. SET lesion lower than 30 mm and the lesion whose endoscopic submucosal dissection attemption was included in the study. The total of 8 patients were four female (50%) and four male (50%), aged 31-66 years (median, 53 years). The tumoral lesions were located 4 (50%) patients in esophagus, 3 (37.5%) patients in stomach and one (12.5%) patient in duodenum and their diameter ranged from 5 to 30 mm (median, 14 mm). Post-interventional no complications or abdominal symptoms were encountered. Also, in early follow-ups for six months, no recurrence was observed. Our experiences together with literature reported here, indicated endoscopic resection is a safe and effective method of treatment for most patients with upper gastrointestinal SETs.

Correlation between the symptoms of upper gastrointestinal disease and endoscopy findings: Implications for clinical practice.

OBJECTIVE: Digestive symptoms are the most common complaints among patients who seek primary healthcare services. This study aims to identify digestive symptoms and determine their association with upper gastrointestinal endoscopy findings in patients treated at a public endoscopy centre in Northeast Brazil. METHODS: We conducted a cross-sectional study using data from 751 patients with digestive symptoms who had an indication for upper gastrointestinal endoscopy. We identified the association between these variables through Fisher's exact test or Chi-square test and calculated the odds ratio. RESULTS: Epigastric pain occurred in 83%, post-prandial plenitude in 72.6%, and heartburn in 72.3% of the patients. Women were more likely to present with epigastric pain (p = 0.001; odds ratio [OR] = 1.25; confidence interval [CI] = 1.07-1.47), post-prandial plenitude (p = 0.001; OR = 1.21; CI = 1.06-1.37), retrosternal pain or burning (p = 0.03; OR = 1.11; CI = 1.004-1.24), heartburn (p = 0.04; OR = 1.10; CI = 0.98-1.24), unintentional weight loss (p = 0.01; OR = 1.12; CI = 1.02-1.24), and dysphagia (p = 0.01; OR = 1.14; CI = 1.03-1.25). There was no statistically significant association between digestive symptoms and endoscopic findings of the upper gastrointestinal tract. Additionally, there was no significant association between digestive symptoms and abnormalities detected by endoscopy. CONCLUSION: Dyspeptic symptoms of epigastric pain, post-prandial fullness, and heartburn were the most common symptoms in patients referred for endoscopy. Dyspepsia, heartburn, and dysphagia were more common in women than in men. Digestive symptoms were not associated with positive endoscopy findings or abnormalities detected by endoscopy.

Influence of metabolic syndrome on upper gastrointestinal disease.

A recent increase in the rate of obesity as a result of insufficient physical exercise and excess food consumption has been seen in both developed and developing countries throughout the world. Additionally, the recent increased number of obese individuals with lifestyle-related diseases associated with abnormalities in glucose metabolism, dyslipidemia, and hypertension, defined as metabolic syndrome (MS), has been problematic. Although MS has been highlighted as a risk factor for ischemic heart disease and arteriosclerotic diseases, it was also recently shown to be associated with digestive system disorders, including upper gastrointestinal diseases. Unlike high body weight and high body mass index, abdominal obesity with visceral fat accumulation is implicated in the onset of various digestive system diseases because excessive visceral fat accumulation may cause an increase in intra-abdominal pressure, inducing the release of various bioactive substances, known as adipocytokines, including tumor necrosis factor-α, interleukin-6, resistin, leptin, and adiponectin. This review article focuses on upper gastrointestinal disorders and their association with MS, including obesity, visceral fat accumulation, and the major upper gastrointestinal diseases.

The changes of main upper gastrointestinal diseases and Helicobacter pylori infection status in the past thirty five years / 中华内科杂志

Objective To study the spectrum of upper gastrointestinal diseases and infection rate of Helicobacter pylori(Hp) in our hospital during the past 35 years.Methods Patients who were 16 or older with duodenal ulcer,gastric ulcer,reflux esophagitis,gastric cancer and esophageal cancer diagnosed by gastroscopy and pathology were retrospectively enrolled in our study from January 1980 to December 2014.Patients with chronic superficial gastritis,chronic atrophic gastritis or Hp infection from January 1989to December 2014 were also included in our study according to the same diagnostic criteria.The incidences of diseases and the infection rates of Hp were studied.Results A total of 213 495 patients underwent gastroscopy in our department during the past 35 years.The overall diagnostic rates of duodenal ulcer,gastric ulcer,reflux esophagitis,gastric cancer and esophageal cancer were 9.87％,3.79％,6.66％,1.59％ and 0.66％ respectively.There were 183 426 patients receiving gastroscopy in our department from January 1989to December 2014.The overall endoscopic diagnosis rates of chronic superficial gastritis and chronic atrophic gastritis were 49.83％ and 22.43％ respectively.The overall infection rate of Hp was 36.18％,which had a declining trend consistent with peptic ulcer (all P =0.000).Yet,the prevalence of reflux esophagitis,chronic superficial gastritis and chronic atrophic gastritis were increasing (all P =0.000).The diagnostic rates of gastric cancer and esophageal cancer were persistent (P =0.266,P =0.156).Conclusions The Hp infection during years has been decreasing,consistent with the declining tendency of peptic ulcer.On the other hand,reflux esophagitis,chronic superficial gastritis and chronic atrophic gastritis show an ascendant trend.The proportion of patients with gastric cancer and esophageal cancer is relatively stable.

Clinical Analysis of Upper Gastrointestinal Diseases in Elderly Patients Underwent Esophagogastroduodenoscopy

Background: Recently the elderly people have increased in Korea. So, the interest of upper gastrointestinal diseases have increased. Our aim was to determine clinical characteristics of upper gastrointestinal diseases in the elderly patients underwent esophagogastroduodenoscopy. Methods: We investigated clinical characteristics of 1190 elderly patients aged 65 years or older and 952 controls aged 64 years or younger who underwent esophagogastrodu odenoscopy in Seonam University Hospital from Jan. 2000 to Dec. 2004. retrospecti vely. Only two main symptoms were included among symptoms of two or over. The endoscopic findings were in the same manner. Results: The average age were 73.9 (+/-7.25)-year-old in the elderly, and 47.2 (+/-11.32)-year-old in controls. The most common symptom was dyspepsia in the elderly and in controls. The most common endoscopic findings showed chronic atrophic gastritis in the elderly, and chronic erythematous & erosive gastritis in controls. 64% was positive in 424 cases performed rapid urease test in the elderly and 63% was positive in controls. The most common associated diseases was hypertension in both group. The history of Non-steroidal anti-inflammatory drugs and aspirins were 21% in the elderly, and 15% in controls. Conclusion: We found that dyspepsia was the most common symptom in the elderly and controls underwent esophagogastroduodenoscopy. The most common upper intestinal disease was chronic atrophic gastritis in the elderly. We recommend esophagogastroduodenoscopy for the elderly patients in regular interval because they may have vague and atypical symptoms or asymptom.

An Aspect of Upper Gastrointestinal Disease among Young Policemen

BACKGROUND: Upper gastrointestinal diseases are relatively important in Korea. There are various studies on upper gastrointestinal diseases, especially relationships with Helicobacter pylori, but studies on young adults are relatively fewer. Therefore, we conducted this study in order to know the prevalence of various upper gastrointestinal diseases and the association with Helicobacter pylori among young policemen. METHODS: Diagnosis and classification of upper gastrointestinal diseases were made 260 policemen, who visited the outpatient department of family medicine at one general hospital in Seoul from March 2, 2001 to December 31, 2002. RESULTS: The frequencies of upper gastrointestinal diseases were gastritis (62.2%), duodenal ulcer (14.4%), gastric ulcer (7.5%), duodenitis (6.9%), and no active lesion (9.0%). The frequency of multiple upper gastrointestinal disease was chronic superficial gastritis and duodenal ulcer (37%), chronic superficial gastritis and duodenitis (21.9%), and acute gastritis and duodenal ulcer (16.4%), and these groups comprised the most with 75.3%. The location of the lesion was found at antrum (62.2%) and duodenum (21.6%). Ulcer stages in gastric and duodenal ulcer were mostly in active stage. Helicobacter pylori infection in gastric and duodenal ulcer were 36% and 85.4%, respectively. CONCLUSION: Most symptomatic patients had lesions which were found at antrum and duodenum as in other studies. Ulcer diseases in duodenum were much more frequent than those in stomach, which probably be associated with Helicobacter pylori. Therefore, suitable examination and treatment are necessary.

Clinical Value of Transnasal Gastroscopy in Diagnosis and Treatment of Upper Gastrointestinal Diseases / 中国微创外科杂志

Objective To evaluate the clinical value of transnasal gastroscopy in diagnosis and treatment of upper gastrointestinal diseases and the endurance of patients to the operation,as well as to measure the distance between the external naris and pectinate line. Methods Between January 2007 and April 2008,totally 3481 patients underwent transnasal gastroscopy in our hospital,meanwhile 3705 patients received routine gastroscopy; 109 patients who received transnasal gastroscopy and 106 patients that underwent routine gastroscopy were surveyed by questionnaires on their tolerance to the procedures. In the transnasal gastroscopy group,210 patients were selected for measuring the distance between the external naris and pectinate line,while 210 patients from the routine gastroscopy group were examined to determine the length from the front teeth to the pectinate line. Results Among the patients underwent transnasal gastroscopy,89.9% (98/109)of them had no or mild nausea and 97.2% (106/109)had no or mild vomiting; 85.5%(53/62) of the patients who had suffered routine gastroscopy reported less pain after transnasal gastroscopy,and 93.6%(102/109)of the patients would like to underwent transnasal gastroscopy again if necessary. The average length from the external naris to pectinate line was (43.1?2.6) cm,which was statistically significantly different from that measured from the incisor teeth to pectinate line by routine gastroscopy [(39.7?1.9)cm,t=15.290,P=0.000]. The diagnostic and differential diagnostic value of transnasal gastroscopy is same to that of routine gastroscopy. Therapies under transnasal gastroscopy were conducted in 38 cases without complications occurred. Conclusions The feasibility,tolerance,and safety of transnasal gastroscopy are superior to routine transoral gastroscopy. It can provide a more comfortable process for examination. The ability of diagnosis and differential diagnosis of transnasal gastroscopy resembles those of routine transoral gastroscopy.

The Relationship of Helicobacter pylori Infection and Upper Gastrointestinal Diseases in Korean Adults

Helicobacter pylori infection is associated with various gastrointestinal disorders. It has been proved that those who are infected leads to gastritis in 100% and that there is no natural recovery. Therefore, treatment to cradicate the organism is essential to block the natural course of many disorders of the gastrointestinal tract, that may lead to gastric cancer which is the number one leading cause of death among cancer in Korea. The study was conducted in order to find out the prevalence of H. pylori infection in Inchon area and the relationship between H. pylori infection and its diverse pathology. The study involved 1,872 applicants screened for Helicobacter pylori infection by serology antibody test in the Health Promotion Center at Inha University Hospital in Inchon, Among them, 1,203(64.3%) were positive including 651 males(67.2%), and 524 females(61,0%). There was no significant statistical difference among age groups. In males of age group 40-49 years of age, and females of age group 50-59, H. pylori infection were most common. There were no differences among the H. pylori positive and negative group with respect to fatally history, past history, lob, lifestyle behavior (including smoking, drinking, and exercise), Epigastaic pain, diarrhea, rectal bleeding were more common and statistically different in H pylori positives compared to those of negatives. In the findings of upper gastrointestinal barium swallow, there were no differences between the two groups. H. pylori positive group showed more endoscopic findings compared to negative group, Out of the 1,239 total findings H pylori positive group showed 873 endoscopic findings as opposed to 366 in the negative group. Among the H pylori positive group, chronic superficial gastritis was most common with 338, followed by gastric crosion 134, duodenal ulcer 53. In the negative group, chronic superficial gastritis was also the most common with 160, followed by gastric crosion 79, and hiatal hernia 32 Gastric subepithelial hemorrhage(p<0.001), duodenal ulcer(p<0.022), intestinal metaplasia(p<0.024) were found to be significantly common in H pylori positive group compared to those of the negative group. Hiatal hernia(p<0.001) was found to be higher in the negative group. The sensitivity and specificity of CLO test performed during the endoscopy procedure were 79.9% and 100%, respectively. The sensitivity and specificity of endoscopic diopsy were 51.9% and 100%, respectively.