D. Stüker

Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

BackgroundObesity is becoming an epidemic health problem and is associated with concomitant diseases, such as sleep apnea syndrome and gastroesophageal reflux disease (GERD). There is no standardized diagnostic workup for the upper gastrointestinal tract in obese patients; many patients have no upper gastrointestinal symptoms, and few data are available on safety of endoscopy in morbidly obese patients.MethodsSixty-nine consecutive diagnostic upper gastrointestinal endoscopies in morbidly obese patients (26 men, 43 women; mean age 43.4xa0±xa010.9xa0years) were prospectively evaluated from January to December 2008 in an outpatient setting before bariatric procedures. Sedation was administered with propofol. Data on sedation, critical events, and examination times were recorded, as well as pathological findings.ResultsThe patients’ mean body mass index was 47.6xa0±xa07.9 (range, 35.1–73.3)xa0kg/m2; 17.4% reported GERD symptoms. The mean duration of the endoscopy procedure (including sedation) was 20.3xa0±xa09.3xa0(range, 5–50)xa0min, and the whole procedure (including preparation and postprocessing) took 58.2xa0±xa019xa0(range, 20–120)xa0min. The mean propofol dosage was 380xa0±xa0150 (range, 80–900)xa0mg. Two patients had critical events that required bronchoscopic intratracheal O2 insufflation due to severe hypoxemia (<60% Sao2). Nearly 80% of patients had pathological findings in the upper gastrointestinal tract. Only 20% reported upper gastrointestinal symptoms. Pathologic conditions were found in the esophagus in 23.2% of the patients, in the stomach in 78.2%, and in the duodenum in 11.6%. The prevalence of Helicobacter pylori infection was 8.7%.ConclusionsUpper gastrointestinal endoscopy can be performed safely. However, careful monitoring and anesthesiological support are required for patients with concomitant diseases and those receiving sedation. Because 80% of the patients with pathological findings were asymptomatic, every morbidly obese patient should undergo endoscopy before bariatric surgery because there may be findings that might change the surgical strategy.

Erratum to: Dysfunction of the Lower Esophageal Sphincter and Dysmotility of the Tubular Esophagus in Morbidly Obese Patients

BackgroundMorbid obesity is associated with gastroesophageal reflux (GERD). The aim of this prospective study was to determine esophageal motility in asymptomatic morbidly obese patients and compare it to non-obese individuals.MethodsForty-seven morbidly obese patients without GERD symptoms and 15 normal weight individuals were divided into four groups according to their body mass index (BMI; group I, <30xa0kg/m2; group II, 35–39.9xa0kg/m2; group III, 40–49.9xa0kg/m2; group IV, ≥50xa0kg/m2). Standard stationary water-perfused manometry was performed for the assessment of anatomy and function of the lower esophageal sphincter (LES). Twenty-four-hour ambulatory pH-metry and measurement of esophageal motility were performed with a microtransducer sleeve catheter. Data are given as mean ± SD, and the results of groups II–IV were compared to the non-obese individuals from group I.ResultsPatients with morbid obesity had significantly lower LES pressures than non-obese individuals (I, 15.1u2009±u20094.9; II–IV, 10.5u2009±u20095.4, mmHg, pu2009<u20090.05 vs. I) and showed an altered esophageal motility with respect to contraction frequency (I, 1.8u2009±u20090.7/min; II–IV, 3.6u2009±u20092.5/min; pu2009<u20090.05 vs. I) and contraction amplitude (I, 38u2009±u200912xa0mmHg; II–IV, 33u2009±u200917xa0mmHg; pu2009<u20090.05 vs. I). Furthermore, these patients had significantly higher DeMeester scores than non-obese individuals. Length and relaxation of the LES as well as propulsion velocity of the tubular esophagus did not differ.ConclusionPatients with morbid obesity (=BMIu2009>u200940xa0kg/m2) have a dysfunction of the LES and an altered esophageal motility, even when they are asymptomatic for GERD symptoms.

New Endoscopic Image Documentation System for the Mobile Use for Example on Intensive Care Units and in the Operation Room

Visual documentation of endoscopic examinations on intensiv care units or in the operation room is often not satisfying. We developed a new image and video documentation system for the mobile use to close this gap. The images are saved on an USB stick and can be easily imported in the regular documentation system of the endoscopy unit. Beside other helpful tools a deinterlacing algorithm to enhance image quality, is integrated.