Preoperative Upper Gastrointestinal Endoscopy in Metabolic and Bariatric Surgery: A Narrative Review of Current Evidence and Clinical Recommendations

Abstract

Metabolic and bariatric surgery (MBS) represents the most effective therapeutic approach for achieving substantial and sustained weight loss and improving obesity-related comorbidities. However, the role of routine preoperative esophagogastroduodenoscopy (EGD) remains controversial, and current recommendations vary among international professional societies. Obesity is associated with a high prevalence of upper gastrointestinal disorders, including gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, gastritis, Helicobacter pylori infection, gastric intestinal metaplasia, and peptic ulcer disease. Importantly, clinically relevant endoscopic abnormalities may occur in asymptomatic patients, limiting the reliability of symptom-based strategies for selecting candidates for EGD. Preoperative endoscopic findings may require medical treatment, additional diagnostic investigations, endoscopic surveillance, or modification of the planned bariatric procedure. This is particularly relevant when considering sleeve gastrectomy in patients with significant reflux-related disease or Barrett’s esophagus, as well as gastric bypass procedures that may limit subsequent endoscopic access to the excluded stomach. This narrative review summarizes current evidence regarding the clinical value of preoperative EGD in MBS, with particular emphasis on relevant gastroesophageal and gastric findings, standardized endoscopic assessment, their implications for surgical decision-making, and current international recommendations.