Endoscopic view inside a stomach showing healthy and inflamed tissue with surgical instruments.

Is Endoscopy Before Bariatric Surgery Always Necessary? What the Data Says

Elliot Brynn in Health & Wellness August 2025 • 4 min read.

"A large study in the Middle East sheds light on the value of routine upper endoscopy before weight loss surgery, challenging conventional wisdom and raising important questions for patients and surgeons."

For individuals considering bariatric surgery, the journey involves numerous pre-operative evaluations to ensure the best possible outcome. One common procedure is an upper endoscopy, where a doctor uses a camera to examine the esophagus, stomach, and duodenum. The question is, is this procedure always necessary?

Morbid obesity is frequently linked to gastrointestinal issues, significantly increasing the risk of conditions like gastroesophageal reflux disease (GERD), erosive esophagitis, and hiatal hernias. In fact, those with obesity are 2 to 3 times more likely to experience upper digestive diseases compared to individuals with a healthy weight, highlighting the importance of thorough pre-operative assessments.

While some surgeons consider upper endoscopy a crucial step to rule out any underlying gastrointestinal diseases that could impact the surgical plan, others argue that it's an unnecessary procedure that exposes patients to potential risks, such as complications from sedation, especially given that many bariatric patients have existing health concerns. A recent study aimed to clarify this debate by reviewing the records of over 1200 patients who underwent preoperative endoscopy before bariatric surgery.

The Value of Routine Endoscopy: What the Study Revealed

Endoscopic view inside a stomach showing healthy and inflamed tissue with surgical instruments.

Researchers in Dubai reviewed the medical records of 1278 patients who had undergone preoperative endoscopy at Rashid Hospital between 2013 and 2016. The study, published in Endoscopy International Open, divided patients into three groups based on endoscopy findings:

Group 0: Patients with normal endoscopy results.
Group 1: Patients with abnormalities that wouldn't affect the timing or type of surgery.
Group 2: Patients with abnormalities that directly impacted the surgical procedure.

The study revealed that only 10.6% of patients had normal endoscopy results. A significant 89.4% showed some form of abnormality. The most common issues included gastritis, positive tests for Campylobacter-like organisms (CLO), and GERD with esophagitis and hiatal hernias. More specifically:

The Bottom Line: Is Endoscopy Right for You?

This study suggests that routine endoscopy plays a significant role in preparing patients for bariatric surgery, particularly in the Middle East. The high prevalence of abnormalities detected through endoscopy led to changes in the surgical plan for a substantial number of patients.

However, it's important to remember that every patient is unique. Factors like your individual risk factors, symptoms, and the specific type of bariatric surgery you're considering will all play a role in determining whether or not an endoscopy is necessary. The decision should be made in consultation with your surgeon, weighing the benefits and risks in your specific case.

As research continues and more data becomes available, guidelines may evolve. This study adds to the growing body of evidence that will help surgeons and patients make informed decisions about the role of preoperative endoscopy in bariatric surgery.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1055/a-0659-2395, Alternate LINK

Title: Role Of Routine Upper Endoscopy Before Bariatric Surgery In The Middle East Population: A Review Of 1278 Patients

Subject: Gastroenterology

Journal: Endoscopy International Open

Publisher: Georg Thieme Verlag KG

Authors: Bassem Abou Hussein, Ali Khammas, Mariam Shokr, Maiyasa Majid, Mariam Sandal, Sameer Al Awadhi, Alya Al Mazrouei, Faisal Badri

Published: 2018-10-01

Everything You Need To Know

What is an upper endoscopy and why is it performed before bariatric surgery?

An upper endoscopy involves using a camera to examine the esophagus, stomach, and duodenum. It is done before bariatric surgery to identify potential gastrointestinal issues like gastroesophageal reflux disease (GERD), erosive esophagitis, and hiatal hernias, which are more common in individuals with morbid obesity. Some surgeons consider it crucial to rule out underlying conditions that could impact the surgical plan.

How did the study group patients based on endoscopy results, and what were the key findings?

The study conducted at Rashid Hospital divided patients into three groups based on their endoscopy results: Group 0 had normal results, Group 1 had abnormalities that didn't affect surgery, and Group 2 had abnormalities that directly impacted the surgical procedure. The research revealed a high percentage of patients (89.4%) showed some form of abnormality.

What types of gastrointestinal abnormalities are commonly detected during routine endoscopy before bariatric surgery?

The study identified several common abnormalities through routine endoscopy before bariatric surgery. These included gastritis, positive tests for Campylobacter-like organisms (CLO), GERD with esophagitis, and hiatal hernias. These findings highlight the prevalence of gastrointestinal issues in patients with morbid obesity.

What are the implications of this study on routine endoscopy before bariatric surgery?

The study indicates that routine endoscopy plays a significant role in preparing patients for bariatric surgery, especially in the Middle East, because the high rate of abnormalities detected often leads to changes in the planned surgical procedure. However, the study does not account for other factors such as geographical location, age of the patients, or other potential conditions outside of the studied conditions.

What are the potential risks and benefits of undergoing an endoscopy prior to bariatric surgery?

While endoscopy can reveal important conditions like gastritis, Campylobacter-like organisms (CLO), GERD with esophagitis, and hiatal hernias, it's also important to consider the potential risks. These can include complications from sedation and the procedure itself. The decision to undergo endoscopy should balance the benefits of detection against these risks, considering individual patient health and risk factors.