Endoscopia preoperatoria en cirugía bariátrica: Es realmente necesaria.

Igor Armando Bello Madrid, José Alejandro Espinola, Dayana Guevara

Resumen


Patologías esofagogástricas son reconocidas antes y después de procedimientos bariátricos, pero frecuentemente y severamente debatidos. Se realizó un estudio con la finalidad de comparar los hallazgos endoscópicos del aparato digestivo superior con los resultados de anatomía patológica en pacientes sometidos a bypass gástrico laparoscópico en Y de Roux  y gastrectomía en manga por obesidad mórbida. Un total de 142 pacientes fueron incluidos en el estudio, todos bajo un régimen de seguimiento. Se hicieron análisis retrospectivos con hallazgos endoscópicos preoperatorios. Los reportes endoscópicos estuvieron disponibles para el total de los pacientes incluidos, asimismo los reportes de biopsias endoscópicas. El promedio de edad fue 34.7 años, 88 (61.9%) pacientes eran mujeres y 54 (38%) hombres. El hallazgo endoscópico patológico predominante fue gastritis erosiva 56.3% (80/142), seguida por gastritis nodular 17.6% (25/142), hernia hiatal tipo I 3.5% (5/142), esofagitis 3.5% (5/142), duodenitis inespecífica 2.8% (4/142), pólipos gástricos 2,8% (4/142), y 18 estudios normales 12.6%. En cuanto a resultados de biopsias reportamos 243 hallazgos y el total no se corresponde con el número de casos en vista que algunos pacientes tenían más de una patología. El hallazgo más frecuente fue gastritis crónica 96.4% (137/142), infección por Helicobacter pylori 40.8% (58/142), hiperplasia foveolar difusa 14.7% (21/142), hiperplasia foveolar focal 15.4% (22/142), pólipos hiperplásicos 2.8% (4/142) y acantosis irregular 0.7% (1/142). Concluyendo de los 142 pacientes estudiados, solo 18 (12.6%) estudios resultaron normales, sin embargo no se corresponden con biopsias indemnes, pero los hallazgos patológicos no tienen relevancia clínica, por lo que ni la endoscopia preoperatoria en el paciente obeso ni el estudio anatomopatológico del estómago y duodeno parecen estar justificados en nuestra población.

Palabras clave


bypass gástrico en-Y-Roux; gastrectomía vertical laparoscópica; endoscopia;biopsia

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Referencias


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DOI: http://dx.doi.org/10.11565/arsmed.v42i1.59



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