P0980 - Prevalence of obesity-related gastrointestinal inflammation prior to sleeve gastrectomy in adolescents

Background: Sleeve gastrectomy (SG) is an effective treatment for obesity in adolescents. One adverse outcome of SG is gastroesophageal reflux disease (GERD). Preoperative gastrointestinal (GI) pathologies are also common in this population. We perform preoperative esophagogastroduodenoscopy (EGD) for all patients undergoing SG. This study aims to determine the prevalence of GI inflammation in adolescents undergoing SG and to assess associations with outcomes.

Methods: We conducted a retrospective study of pathology reports from all EGD biopsies performed for adolescents undergoing SG from September 2017 to December 2019. We correlated preoperative EGD findings with antacid usage as a surrogate for GERD. Percentage weight loss was measured at 1, 6, and 12 months after surgery. Weight loss was compared between patients with and without preoperative GI inflammation using Student’s t test.

Results: During the study period, 23 adolescents underwent laparoscopic SG. The cohort was 39.1% male (n=9), 78.3% African American (n=18), and had mean body mass index (BMI) of 54.2±11 kg/m2. Mean weight loss was 22.8% of total body weight 12 months after surgery. Preoperative EGD identified 6 (26.1%) patients with esophageal inflammation, 8 (34.8%) with gastric inflammation, and 8 (34.8%) with duodenal inflammation. Seventeen patients (73.9%) had inflammation of at least one area, 5 (21.7%) were Helicobacter pylori positive, and 1 (4.3%) had a gastric ulcer that delayed surgery. Only 2 patients (8.7%) were taking antacid medications prior to EGD, indicating that most inflammation was silent/untreated. Patients with preoperative gastric inflammation lost significantly less weight 12 months after SG compared to patients without gastric inflammation (p = 0.028, Table 1).

Conclusions: Adolescents with obesity have a high prevalence of GI pathologies. Gastric inflammation is associated with poor weight loss after SG. EGD findings may also change surgical planning in some patients. We recommend that all adolescents undergo EGD prior to SG.