Latif YILMAZ, Alper AYTEKIN, İlyas BAŞKONUŞ
Journal of Comprehensive Surgery - 2026;4(1):10-16
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 (H. 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 H. 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.
