The Utility of Routine Esophagogastroduodenoscopy Prior to Laparoscopic Roux-en-Y Gastric Bypass
Bibliographic record
Abstract
Currently, esophagogastroduodenoscopy (EGD) is recommended for symptomatic patients prior to laparoscopic Roux-en-Y gastric bypass (LRYGB), but the use of EGD for routine screening in asymptomatic patients is debatable. We aimed to study the utility of routine EGD in patients undergoing LRYGB.A retrospective review of consecutive patients undergoing LRYGB with one surgeon at our hospital from May 2014 to March 2016 was completed. Data for these participants were collected using from patient clinical records. All patients had preoperative EGD with biopsies. EGD findings were compared with findings from surgical gastrojejunal (GJ) anastomoses pathology and postoperative complications.116 patients were identified with an average age of 46.2 u00b1 10.3 years and 70.7% were female. Of the 113 patients with reported EGDs, 52 patients (46.0%) had normal EGD, 46 (40.7%) had at least one EGD pathology but did not result in change of management, and 15 (13.3%) had EGD pathologies resulting in change of management. Sixteen patients (13.8%) were found to have chronic gastritis of the GJ anastomosis. The relative risk of patients with gastritis in the GJ specimen was 5.1 (p < 0.001) for patients with gastritis on EGD, and also 5.1 (p < 0.001) for patients with HP on EGD. Seventeen patients (14.7%) had complications following surgery, eleven of which had marginal ulcers. The relative risk of patients with marginal ulcers was 1.1 (p = 0.84) for patients with gastritis on EGD, and 1.9 (p = 0.38) for patients with HP on EGD. No anastomotic leaks were identified. Routine EGD only identified abnormalities leading to change in management in 13.3% of patients, and abnormalities on EGD did not significantly associate with postoperative complications. Based on the findings from this study, we recommend using less invasive screening in the routine workup of patients awaiting LRYGB, and reserving EGD for symptomatic patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".