Before weight loss surgery, most bariatric surgeons will require their patients to have an upper endoscopy with a gastroenterologist to review the anatomy of their stomach and esophagus. A gastroenterology appointment before weight loss surgery is really about risk management. By sending you to a gastroenterology consultation to evaluate your esophagus and your stomach, we look for three things. We like to evaluate these things on the front end to understand how to address them, lowering your risk of complications from surgery. 

Purpose of the Gastroenterology Appointment

Signs of abnormalities in the mucosa of your esophagus

Mucosa is moist tissue that lines parts of the body, including your nose, esophagus, mouth, and stomach. Patients who experience chronic reflux (GERD), infections, or trauma from taking medications are more at risk of developing cancers in the esophagus. Although these changes (reflux, infections, and medications), do not directly cause cancer, they result in a reactive change in the lining of the esophagus that increases the risk of developing cancer.

Therefore, when we preform a gastroscopy, we will look for any signs of reactive changes in the mucosa (lining of the esophagus) that could lead to cancer.

Searching for a hiatal hernia

A hiatal hernia occurs when part of the stomach slides into the chest through a hole in the diaphragm called the hiatus. When this happens, it places the stomach in an unnatural position, causing a range of problems from reflux (heartburn), to chest pain and vomiting. During the gastroenterology appointment, we are looking for any signs of a hiatal hernia that might need to be repaired prior to bariatric surgery.

Hiatal hernia development is due to weakened muscle tissue that allows the stomach to bulge up through your diaphragm. Patients who carry around excess weight experience an increase in intra-abdominal pressure. Yet, aside from weight gain being one of the most common reasons people develop a hiatal hernia, heavy lifting and genetics can also play a role in the development.

Similarly, patients who experience weight regain after bariatric surgery can have the recurrence or even initial development of a hiatal hernia. And the development of a hiatal hernia after bariatric surgery will act the same way—causing reflux, chest pain, and in some cases, vomiting.

Appearance of any H-Pylori bacteria in the stomach

Helicobacter pylori (H. pylori) infection occurs in the stomach and increases the chances of ulcerative formation after bariatric surgery. Although the prevalence of H-Pylori bacteria in the stomach is not deadly, it can lead to some uncomfortable symptoms such as aches or burning sensations in the abdomen, nausea, vomiting, loss of appetite, reflux, and bloating.

Nearly 25% of pre-op bariatric patients have H-Pylori present in the gut and therefore this is something we are on the look-out for. We want to decrease a patient’s chances of discomfort and complications after surgery, and this includes reducing their risk of developing ulcers post-operatively.

What to Expect at the First Gastroenterology Appointment

In general, the process for the gastroenterologist typically involves an appointment to go through your medical history with them. Secondly, the gastroenterologist will perform an EGD.

An EGD (esophagogastroduodenoscopy) is an endoscopic procedure that allows your doctor to examine your esophagus, stomach, and duodenum. You come into a surgery suite and undergo some mild anesthesia. They do the procedure, and because it is outpatient, you can go home later that day. The process should only take 30 to 60 minutes, and typically, you will need someone to drive you home after. 

Once we get the results back within a week, the gastroenterologist will give you a call and go over those with you and hopefully give you clearance to move forward. 

Sometimes, depending on your age and symptomology, we find that patients have other issues such as colon bleeding or stomach issues that may subsequently require a colonoscopy. We have been unfortunate to have seen patients who have had esophageal, stomach, or colon cancer. Still, with these appointments, we can treat these cancers early enough that the patient could navigate these with minimum side effects and with the best outcomes for their health. 

Conclusion

A gastroenterology appointment is crucial to the process of weight loss surgery. Going into your first appointment, there is nothing to be afraid of. If you’d like to make an appointment with a bariatric specialist to talk more about the gastroenterology process or to get started on your weight loss surgery journey.

Original post by Dr. Donald Maynard on Bariatric Centers of America