Routine endoscopy prior to bariatric surgery: evidence-based necessity or institutional tradition?

Abstract Obesity, a growing global health challenge, requires effective treatment modalities, among which bariatric surgery is the gold standard for patients with Class III obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities). While surgical outcomes are well established, the role of routine preoperative Esophagogastroduodenoscopy (EGD) remains debated. This study evaluates the role of EGD in preoperative planning among a Turkish cohort. We conducted a retrospective cross-sectional analysis of 117 patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) between 2018 and 2021. Data on demographics, comorbidities, endoscopic and histopathologic findings, and surgical modifications were collected. Preoperative EGD revealed pathology in 86.3% of patients, including antral gastritis (64.1%), hiatal hernia (22.2%), and erosive esophagitis (18.8%). Chronic gastritis was confirmed histopathologically in 74.4%, and active Helicobacter pylori infection was identified in 15.4% of surgical specimens. Notably, EGD findings led to changes in surgical management in 18.8% of cases. Our findings support the utility of routine EGD in bariatric surgery, emphasizing its role in identifying otherwise undetected pathologies that influence surgical decision-making. Further multicenter prospective studies are warranted.