P2740 - Prevalence and Characteristics of Gastric Intestinal Metaplasia in Patients Undergoing Bariatric Surgery

Joseph El Dahdah, MD¹, Baila Elkin, MD², Joseph Kassab, MD², Shailja C. Shah, MD, MPH³, Michelle Kim, MD², C. Roberto Simons-Linares, MD¹, Carol Rouphael, MD^1
1Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Jennifer Moreno Veteran Affairs San Diego Healthcare System, San Diego, CA

Introduction: Gastric intestinal metaplasia (GIM) is a precursor for gastric cancer in some high-risk patients. While endoscopy (EGD) pre-bariatric surgery is suggested, it is not a mandatory recommendation for all patients. Guidance on bariatric surgery type in GIM patients is lacking. Of particular concern is Roux-en-Y gastric bypass (RYBG), which hinders surveillance of the gastric remnant. We hence sought to investigate the prevalence of GIM in bariatric patients undergoing EGD and whether the presence of GIM led to a change in surgical plan.

Methods: We conducted a retrospective cohort study of patients who underwent bariatric surgery at our institution between 1/2018 and 12/2021. Demographic, clinical, surgery-related plans pre and post-EGD, endoscopic and pathology data were gathered. We defined pre-bariatric surgery EGD if performed ≤1 year from surgery date. Statistical analysis was performed to assess GIM patients’ prevalence and characteristics.

Results: A total of 3,729 patients were included. Of those, 37% (N=1378) had EGD performed ≤1 year from surgery date, with gastric biopsies taken in 72% (N=993) of cases. Among patients who underwent EGD with biopsies, GIM prevalence was 2% (N=20). Patients with GIM had a mean age of 53±13.5 and body mass index of 44.5 ±5.9. Among patients with GIM, 50% had “pre-bariatric assessment” as an indication for the EGD, with heartburn being the second most common one. Gastric mucosal changes and empiric biopsies appeared to be the reason for biopsies in 70% and 30% of cases respectively. GIM extent was limited in 15% of cases, extensive in 15% and unknown in 70%. Only 2 patients had RYGB and the rest underwent a sleeve gastrectomy (SG). None of the SG surgical specimens had GIM on pathology review. There were no changes in surgical plans driven by a GIM finding for any of the patients, particularly RYGB cases. GIM patients’ characteristics are presented in Table 1.

Discussion: Less than 50% of patients undergoing bariatric surgery had an EGD prior to bariatric surgery. GIM prevalence was 2% when biopsies were taken. GIM extent was unknown in 70% of cases. More studies are needed to assess the true prevalence of GIM in patients undergoing bariatric surgery, as well as the need for EGD with empiric biopsies to rule out GIM and determine GIM extent pre-bariatric surgery, particularly before RYGB.


Disclosures:


Joseph El Dahdah, MD¹, Baila Elkin, MD², Joseph Kassab, MD², Shailja C. Shah, MD, MPH³, Michelle Kim, MD², C. Roberto Simons-Linares, MD¹, Carol Rouphael, MD¹. P2740 - Prevalence and Characteristics of Gastric Intestinal Metaplasia in Patients Undergoing Bariatric Surgery, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.