Review Article

Interconnection of severe obesity, gastric intestinal metaplasia, gastric cancer, bariatric surgery and the necessity of preoperative endoscopy

¹ Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Iran University of Medical Sciences, 1445613131 Tehran, Iran
² Iran National Center of Excellence for Minimally Invasive Surgery Education, 1445613131 Tehran, Iran
³ Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, 5714783734 Urmia, Iran
⁴ Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, 1445613131 Tehran, Iran

^* Corresponding author: mkermansaravi@yahoo.com, Kermansaravi.m@iums.ac.ir
^** rohvali4@gmail.com

Received: 4 March 2022
Accepted: 22 September 2022

Abstract

Obesity is a growing challenge around the globe accounting for approximately 1.7 billion adults with reduced life expectancy of 5–20 years and these patients are at greater risk for various cancers. Bariatric surgery is one efficient an approved treatment of severe obesity for losing weight and to decrease associated health complications. Besides correct indications and contraindications as well as the various risks of individual bariatric surgical procedures, many more variables influence decision-makings, such as patient’s family history of diseases, as well as individual patient-specific factors, patient and family socioeconomic and nutrition status, and professionalism of a bariatric surgical unit and the presence of intestinal metaplasia that is the replacement of columnar epithelial cells by intestinal architecture and morphology. Patients with severe obesity undergoing esophagogastroduodenoscopy (EGD) and biopsy prior to bariatric surgery may present with gastric IM because regular follow-up to early diagnosis of any subsequent pathological changes is necessary and reveals the importance of addressing interconnections between pre-existing conditions and outcomes. However, there is currently no unified recommendation about preoperative EGD before bariatric surgery. With this short review, we point out the necessary knowledge that undermines why the responsibility for a patient with severe obesity cannot be divided across various disciplines, and why we recommend that EGD always be performed preoperatively.