JOCS
Journal of Comprehensive Surgery

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields.

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Original Article
Diagnostic value of routine preoperative esophagogastroduodenoscopy and concordance with sleeve gastrectomy specimen histopathology: a single-center retrospective study
Abstract
Aims: The role of routine preoperative esophagogastroduodenoscopy (EGD) before laparoscopic sleeve gastrectomy (LSG) remains controversial. Although EGD may identify clinically relevant pathology that influences surgical planning, its routine use and concordance with postoperative histopathological findings continue to be debated. The aim of this study was to evaluate the diagnostic yield of preoperative EGD and its concordance with sleeve gastrectomy specimen histopathology.
Methods: This retrospective, single-center observational study included adult patients who underwent primary LSG between January 2017 and June 2025 and had both preoperative EGD (with endoscopic biopsy when performed) and postoperative sleeve gastrectomy specimen histopathology available. Preoperative endoscopic findings, endoscopic biopsy results when performed, and final specimen histopathology were analyzed descriptively to assess diagnostic yield and preoperative–postoperative concordance.
Results: A total of 305 patients were included. Preoperative EGD identified reflux esophagitis in 17.4% of patients and hiatal hernia in 3.9%. Endoscopic biopsy was performed in 37.4% of patients, with Helicobacter pylori detected in 50.9% of biopsied cases. In contrast, H. pylori positivity in sleeve gastrectomy specimens was markedly lower (12.1%). No dysplasia or malignancy was identified in either preoperative biopsy specimens or postoperative sleeve gastrectomy specimens. Intestinal metaplasia was rare in surgical specimens (0.7%).
Conclusion: Preoperative EGD may contribute to safer surgical planning in patients undergoing LSG by identifying reflux-related pathology that can influence operative decisions. However, the rarity of high-grade premalignant or malignant lesions in this cohort does not support a universal requirement for routine EGD or postoperative histopathological examination in all patients. A selective, risk-adapted approach to preoperative EGD, together with standardized management of Helicobacter pylori, appears to represent a balanced strategy, while the role of specimen histopathology as a potential safety measure should be considered according to institutional patient profiles and available resources.

Keywords : Obesity, upper gastrointestinal diseases, endoscopy, helicobacter pylori, gastritis, bariatric procedures

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1. Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197-1209. doi: 10.1016/S0140-6736(05)67483-1
2. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741-752. doi:10.1056/NEJMoa066254
3. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes: 5-year outcomes. N Engl J Med. 2017;376(7):641-651. doi:10.1056/NEJMoa1600869
4. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2020-2021: current trends for bariatric and metabolic procedures. Obes Surg. 2024;34(4):1075-1085. doi:10.1007/s11695-024-07118-3
5. Campos GM, Mazzini GS, Altieri MS, et al. ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery. Surg Obes Relat Dis. 2021;17(5):837-847. doi:10.1016/j.soard.2021.03.007
6. Quake SYL, Mohammadi-Zaniani G, Musbahi A, Old O, Courtney M, Small P. Routine use of esophagogastroduodenoscopy in bariatric surgery: an international survey of current practice. Obes Surg. 2022; 32(11):3627-3634. doi:10.1007/s11695-022-06252-0
7. Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery on bariatric surgery: update 2020. Surg Endosc. 2020;34(6):2332-2358. doi: 10.1007/s00464-020-07555-y
8. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427-436. doi:10.1007/s11695-012-0864-0
9. Bennett S, Gostimir M, Shorr R, Mallick R, Mamazza J, Neville A. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12(5): 1116-1125. doi:10.1016/j.soard.2016.04.012
10. Moulla Y, Lyros O, Mehdorn M, et al. Preoperative upper gastrointestinal endoscopy prior to bariatric surgery: essential or optional?. Obes Surg. 2020;30(6):2076-2084. doi:10.1007/s11695-020-04485-5
11. Parikh M, Liu J, Vieira D, et al. Preoperative endoscopy prior to bariatric surgery: a systematic review and meta-analysis of the literature. Obes Surg. 2016;26(12):2961-2966. doi:10.1007/s11695-016-2232-y
12. Brown WA, Johari Halim Shah Y, Balalis G, et al. IFSO position statement on the role of esophagogastroduodenal endoscopy prior to and after bariatric and metabolic surgery procedures. Obes Surg. 2020;30(8):3135-3153. doi:10.1007/s11695-020-04720-z
13. Alessandris R, Moroso F, Michelotto M, et al. Preoperative endoscopy and pathology report of the specimen: should they be recommended in sleeve gastrectomy?. Pathologica. 2023;115(2):90-96. doi:10.32074/1591-951X-781
14. Elkin B, El-Dahdah J, Yang Q, et al. Preoperative upper endoscopy and surgical specimen findings in bariatric surgery patients. Obes Surg. 2025;35(7):2736-2744. doi:10.1007/s11695-025-07958-7
15. Chang VC, Pan P, Shah SK, et al. Routine preoperative endoscopy in patients undergoing bariatric surgery. Surg Obes Relat Dis. 2020;16(6): 745-750. doi:10.1016/j.soard.2020.02.002
16. Praveenraj P, Gomes RM, Kumar S, et al. Diagnostic yield and clinical implications of preoperative upper gastrointestinal endoscopy in morbidly obese patients undergoing bariatric surgery. J Laparoendosc Adv Surg Tech A. 2015;25(6):465-469. doi:10.1089/lap.2015.0041
17. Salama A, Saafan T, El Ansari W, Karam M, Bashah M. Is routine preoperative esophagogastroduodenoscopy screening necessary prior to laparoscopic sleeve gastrectomy? Review of 1555 cases and comparison with current literature. Obes Surg. 2018;28(1):52-60. doi:10.1007/s11695-017-2813-4
18. Ogle S, Derderian SC, Kramer R, Anthony R, Inge T. The role of preoperative upper endoscopy in adolescents undergoing laparoscopic vertical sleeve gastrectomy. Surg Obes Relat Dis. 2020;16(9):1212-1217. doi:10.1016/j.soard.2020.04.051
19. Zidan MH, Abokhozima A, Gaber MIA, et al. Trends and practices in bariatric surgery in Egypt: insights on esophagogastroduodenoscopy utilization and surgical volumes. Obes Surg. 2025;35(7):2528-2548. doi: 10.1007/s11695-025-07846-0
20. Bellorin O, Senturk JC, Cruz MV, Dakin G, Afaneh C. Predictive factors for developing gastroesophageal reflux disease after sleeve gastrectomy: is preoperative endoscopy necessary? J Gastrointest Surg. 2022;26(5): 1015-1020. doi:10.1007/s11605-021-05207-7
21. Heiat M, Javanbakht M, Abyazi MA, Modarresi F, Gholizadeh H. How reliable is pre-sleeve endoscopy to characterize pathological features? Ann Diagn Pathol. 2024;72:152319. doi:10.1016/j.anndiagpath.2024.152319
22. Owen CK, Felinski MM, Bajwa KS, et al. Frequency of clinically significant findings in the surgical pathology specimen following laparoscopic sleeve gastrectomy and concordance with preoperative endoscopy: insights from a large single-center experience. Obes Surg. 2024;34(5):1442-1448. doi:10.1007/s11695-024-07155-y
23. Di Palma A, Alhabdan S, Maeda A, et al. Unexpected histopathological findings after sleeve gastrectomy. Surg Endosc. 2020;34(5):2158-2163. doi:10.1007/s00464-019-07002-7
24. Briggs H, Nevins EJ, Musbahi A. Histopathological examination of 404 sleeve gastrectomy specimens at a large UK center and systematic review of the published literature. Obes Surg. 2025;35(1):263-270. doi:10.1007/s11695-024-07641-3
25. Di Palma A, Alhabdan S, Maeda A, et al. Preoperative Helicobacter pylori screening and treatment in patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2020;30(7):2816-2820. doi:10.1007/s11695-020-04436-0
26. Onzi TR, d’Acampora AJ, de Araújo FM, et al. Gastric histopathology in laparoscopic sleeve gastrectomy: pre- and postoperative comparison. Obes Surg. 2014;24(3):371-376. doi:10.1007/s11695-013-1107-8
Article available in :
Volume 4, Issue 1, 2026
Page : 10-16
https://doi.org/10.51271/JOCS-0069
Article Information
Received : 17 Oca 2026
Accepted : 12 Şub 2026
Published : 24 Şub 2026
Corresponding Author :

Latif Yılmaz: Department of General Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye

[email protected]
Citation : Yılmaz L, Aytekin A, Başkonuş İ. Diagnostic value of routine preoperative esophagogastroduodenoscopy and concordance with sleeve gastrectomy specimen histopathology: a single-center retrospective study. J Compr Surg. 2026;4(1):10-16.

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