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The role of upper endoscopy in the preoperative evaluation of patients undergoing bariatric surgery may be based, in part, on the presence or absence of symptoms. The rationale for performing an EGD is to identify and treat lesions that affect the type of surgery performed, cause complications in the immediate postoperative period, or result in symptoms after surgery.

When an endoscopy is considered in a patient who has had bariatric surgery, the endoscopist should be aware of the operative procedure performed, the findings on preprocedural imaging studies and they must understand the expected anatomy. The guidelines advise direct communication with the surgeon if possible. Endoscopy in the postoperative patient may be used to evaluate and treat a variety of conditions including: symptoms of nausea, vomiting and abdominal pain; marginal ulcers; gastroesophageal reflux disease (GERD); gastric leaks and gastrogastric fistulas; stenosis (abnormal narrowing of the stomach or intestine); dumping syndrome (rapid emptying from the stomach into the small bowel); bezoars (food that forms into a hard mass); band erosion or slippage; bleeding and anemia; diarrhea and nutritional deficiencies; choledocholithiasis (the presence or formation of gallstones); and weight regain.

Bariatric surgical intervention presents new challenges to the endoscopist:

• An upper endoscopy should be performed in all patients with upper-GI-tract symptoms who are to undergo bariatric surgery.

• Upper endoscopy should be considered in all patients who are to undergo a Roux-en-Y gastrojejunal bypass (RYGB), regardless of the presence of symptoms.

• In patients without symptoms and who are not undergoing an endoscopy, noninvasive H pylori testing followed by treatment, if positive, is recommended.

• In patients without symptoms and who were undergoing gastric b
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