THE PLACE OF UPPER GASTROINTESTINAL-TRACT ENDOSCOPY BEFORE AND AFTER VERTICAL BANDED GASTROPLASTY FOR MORBID-OBESITY

In industrialized countries, surgical gastroplasty is performed more a nd more frequently in patients with morbid obesity. The aims of this p rospective study were to determine the incidence of upper gastrointest inal lesions in obese patients and to assess the place of digestive en doscopy in symptomatic patients after gastroplasty. A consecutive grou p of 159 obese patients were studied before and after Vertical banded gastroplasty. In the preoperative evaluation, reflux esophagitis and g astroduodenal lesions were endoscopically observed in 31% and 37% of t he patients, respectively Interestingly, the majority of the obese pat ients with upper gastrointestinal lesions were asymptomatic. In the po stoperative follow-up period, 55 of the 159 patients complained of upp er gastrointestinal symptoms such as vomiting (72%), esophageal reflux (17%), and epigastric pain (3%). Stenosis of the outlet of the gastri c pouch was described in 40 of the 55 symptomatic patients. Esophagiti s was observed in 60% of these patients. Endoscopic dilation using Sav ary bougies or TTS balloon was successfully performed in all the patie nts with symptomatic stenosis of the gastric outlet. Food impaction wa s endoscopically removed in four patients. Thus, we recommend performi ng an upper gastrointestinal endoscopy in obese patients who are candi dates for surgical gastroplasty because of the high incidence of upper gastrointestinal peptic lesions. Endoscopy is also helpful in patient s with digestive disorders occurring after gastroplasty in order to de fine and to treat the lesions.