Severe obesity in the pediatric population has lifelong consequences. Bariatric surgery has been suggested for selected adolescents with severe obesity after careful evaluation. The indications for preoperative esophagoenteroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD prior to bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities.
We conducted a retrospective chart review in a single tertiary pediatric medical center of adolescents treated during 2011-2018. Data collected from electronic medical records included patient demographics, endoscopic findings, and laboratory parameters.
A total of 80 patients (40 males) underwent evaluation. Macroscopic abnormalities were detected in 54% of the endoscopies, including gastritis, esophagitis, and duodenitis in 46%, 16%, and 13%, respectively. Forty-nine percent of the biopsies showed histological abnormalities; in 35 (44%) patients, Helicobacter pylori (H. pylori) was detected. Thirty-three patients (41%) received medical treatment and two (2.5%) required a second EGD. Metabolic comorbidities included hypertriglyceridemia (38% of the patients), low HDL (23%), and pre-diabetic (16%) or diabetic levels of HbA1C (4%). Fifty-five percent of the cohort had elevated alanine aminotransferase (ALT), suggestive of nonalcoholic fatty liver disease.
Endoscopies performed prior to bariatric surgeries suggest a higher prevalence of clinically significant findings, many of which required treatment. These findings support incorporating an EGD into the preoperative evaluation of this patient population.

Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology.