Trends and Practices in Bariatric Surgery in Egypt: Insights on Esophagogastroduodenoscopy (EGD) Utilization and Surgical Volumes.

BACKGROUND

Esophagogastroduodenoscopy (EGD) is crucial in bariatric surgery for detecting gastro-esophageal conditions and incidental pathologies, impacting surgical decisions and outcomes. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommends routine EGD before and after bariatric procedures to identify incidental pathologies. However, global adherence to these guidelines varies, especially in resource-constrained settings where economic limitations often dictate practice patterns. This study adapts a survey by Quake et al. (2022) to the Egyptian context, offering a comprehensive analysis of EGD utilization alongside broader trends in metabolic and bariatric surgery (MBS) practices in Egypt.

METHODS

A survey adapted from Quake et al. (2022) was tailored to assess trends in metabolic and bariatric surgery (MBS) practices in Egypt. Conducted between April and August 2024 with a response rate of 53.3%, the survey targeted Egyptian bariatric surgeons. It evaluated EGD utilization, surgical expertise, institutional volumes, types of procedures, revisional surgeries, and adherence to the 2020 IFSO position statement. Data was collected through Google Forms and analyzed for trends, challenges, and gaps in practice, focusing on economic constraints and guideline implementation.

RESULTS

Among the 80 respondents, 88.8% were consultants, with 73.8% performing over 100 surgeries annually. The volume of bariatric procedures increased from 2021 to 2023, with significant growth in sleeve gastrectomy (SG) and single-anastomosis sleeve ileal (SASI) bypasses/bipartition. Revisional surgeries were most commonly Roux-en-Y gastric bypass (RYGB). Despite this growth, EGD utilization remained limited. Pre-operatively, only 12.5% of surgeons performed EGD routinely for all patients, while 67.5% used it selectively based on patient or procedural factors. Post-operative EGD at one year was routinely offered by just 3.8% of surgeons, with 55% not routinely using it at all. Institutional and economic factors influenced these practices; surgeons in high-volume or private settings were more likely to adopt selective EGD use. Awareness of the 2020 IFSO guidelines showed a minimal impact on EGD practices, suggesting that financial considerations often outweigh clinical recommendations.

CONCLUSIONS

This study highlights critical trends in bariatric surgery practices in Egypt, including increasing procedural volumes and the limited utilization of EGD. Economic constraints remain the predominant barrier to routine EGD use, despite its potential to improve surgical outcomes by identifying incidental pathologies. Enhancing patient care requires establishing a national registry, upgrading training programs, and implementing observerships to align with international standards are pivotal in advancing bariatric care in Egypt and guaranteeing high-caliber, evidence-based patient care.