Clinical and Esophagogastroduodenoscopy Findings in Pediatric Patients With Severe Obesity Evaluated Before Bariatric Surgery

Rachel Frenklak Sivan, Michal Rozenfeld Bar Lev, Ari Silbermintz, Yael Mozer-Glassberg, Emmanuelle Seguier-Lipzyc, Shlomit Shalitin, Patrick Stafler, Simona Tiroler, Raanan Shamir, Orith Waisbourd-Zinman

Research output: Contribution to journalArticlepeer-review


Objectives: 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 esophagogastroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD before bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities. Methods: We conducted a retrospective chart review in a single tertiary pediatric medical center of adolescents treated during 2011 to 2018. Data collected from electronic medical records included patient demographics, endoscopic findings, and laboratory parameters. Results: A total of 80 patients (40 boys) underwent evaluation. Macroscopic abnormalities were detected in 54% of the endoscopies, including gastritis, esophagitis, and duodenitis in 46%, 16%, and 13%, respectively. Forty-nine percentage of the biopsies showed histological abnormalities; in 35 (44%) patients, Helicobacter pylori was detected. Thirty-three patients (41%) received medical treatment and 2 (2.5%) required a second EGD. Metabolic comorbidities included hypertriglyceridemia (38% of the patients), low high-density lipoprotein (23%), and prediabetic (16%) or diabetic levels of HbA1C (4%). Fifty-five percentage of the cohort had elevated alanine aminotransferase (ALT), suggestive of nonalcoholic fatty liver disease (NAFLD). Conclusions: Endoscopies performed before 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.

Original languageEnglish
Pages (from-to)854-858
Number of pages5
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number6
StatePublished - 1 Jun 2021


  • Adolescent
  • Adult
  • Bariatric Surgery
  • Child
  • Endoscopy, Digestive System
  • Helicobacter pylori
  • Humans
  • Male
  • Obesity, Morbid/complications
  • Retrospective Studies
  • diabetes
  • gastritis
  • metabolic syndrome
  • nonalcoholic fatty liver disease

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health


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