Egyptian survey reveals trends in bariatric surgery practices
- owenhaskins
- 11 minutes ago
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A survey of Egyptian metabolic and bariatric surgeons (MBS) has revealed that procedural volumes are increasing, although economic constraints remain the predominant barrier to routine esophagogastroduodenoscopy (EGD) use, despite its potential to improve surgical outcomes by identifying incidental pathologies, according to the study by the Collaborative Egyptian National Survey Group.
The study authors concluded that “enhancing patient care requires establishing a national registry, upgrading training programmes and implementing observerships to align with international standards are pivotal in advancing bariatric care in Egypt and guaranteeing high-calibre, evidence-based patient care.”
The survey was an adaptation of an earlier surgery by Quake et al(1) to reflect an Egyptian context, offering a comprehensive analysis of EGD utilisation, surgical expertise, institutional volumes, types of procedures, revisional surgeries and adherence to the 2020 IFSO position statement. Conducted between April and August 2024, they received responses from 53.3% (80/150) of Egyptian bariatric surgeons. The majority (88.8%) were consultants with 73.8% (n = 59) high caseload experts (>100 cases annually).
They report that bariatric surgery has consistently grown over the past few years with 57.5% of units conducting more than 100 cases in 2021, 68.8% in 2022 and 73.8% in 2023. During this period, SG increased with over 40% of surgeons performing more than 100 cases in 2023, up from 33.8% in 2021. Primary OAGB procedures exceeding 100 cases also increased reaching 17.5% in 2023 from 15% in 2021. However, primary RYGB procedures displayed varied trends, with a slight increase in the 25–49 cases category but stable numbers for those performing over 100 cases. However, primary banded (or ring-augmented) procedures such as BSG, BOAGB, and BRYGB maintained low overall numbers and did not show significant growth.
Single-anastomosis sleeve ileal (SASI) bypass also increased from 31.3% in 2021 to 35% in 2023. However, the single-anastomosis sleeve jejunal (SASJ) bypass and plication procedures remained relatively stable over this period. Resectional OAGB and single-anastomosis plication ileal (SAPI) bypass demonstrated a modest rise, while the Adjustable Gastric Band (AGB) procedures saw a slight increase in surgeons performing fewer than 25 cases, but overall frequency remained low.
Revisional RYGB remained the most common revisional procedure, while revisional SG or re-sleeve procedures experienced a minor increase from 2.5% in 2021 to 3.8% in 2022 but declined slightly in 2023. Revisional SASI procedures saw a notable rise from 1.3% in 2021 to 5% in 2022, maintaining this level into 2023. Other revisional interventions, such as revisional OAGB and revisional BRYGB, showed minimal variation in frequency, indicating a consistent but limited utilization in surgical practice.
EGD
The utilisation of EGD before bariatric surgery among surgeons for asymptomatic patients showed wide variation. A majority of respondents (67.5%) reported selective use of EGD based on specific criteria including revisional surgeries, patient factors (age, sex, family history), and procedural factors (type of bariatric surgery such as LSG, RYGB, or OAGB). Only 12.5% of surgeons routinely conducted EGD for all patients before bariatric surgery, while 20% did not offer it routinely . The decision to selectively perform EGD was primarily influenced by the type of surgery planned, with revisional surgeries being a major determinant (32.5%). Other commonly cited factors included family history of gastrointestinal disease (23.8%) and patient age (22.5%).
The IFSO 2020 recommendations on the routine use of EGD in bariatric surgery seem to have had little influence on the actual implementation of EGD both pre- and post-operatively among surgeons in Egypt. Among surgeons who are aware of the recommendations, 61.2% offer EGD selectively before bariatric surgery, compared to 77.4% of those who are unaware of the recommendations, indicating no significant correlation between recommendations awareness and pre-operative EGD practices (p=0.273).
Similarly, for post-operative EGD at one-year, 42.9% of aware surgeons offer it selectively, while 38.7% of unaware surgeons do so, reflecting a minimal difference (p=0.904). Furthermore, in terms of the frequency of offering EGD every 2–3 years for patients with specific bariatric procedures (e.g., SG, OAGB, RYGB), no significant differences were observed between those aware and unaware of the guidelines.
“This indicates that awareness of the IFSO recommendations does not substantially influence the clinical decisions regarding the routine use of EGD in bariatric surgery practices in Egypt,” the authors stated.
The study authors concluded that several initiatives are crucial to ensuring that all patients benefit from optimal care informed by accurate data and consistent with global best practices. These include:
Establishing a national registry to elevate the quality of bariatric care across Egypt, such a registry would provide accurate, evidence-based insights into the true extent of bariatric surgeries and their outcomes, facilitating better policy-making, resource allocation and clinical management
Addressing economic constraints to improve access to necessary diagnostic tools
Introducing a certified bariatric training curriculum, coupled with enhanced observership programmes, to facilitate the adoption of contemporary guidelines in surgical practice in Egypt.
The findings were reported in the paper, ‘Trends and Practices in Bariatric Surgery in Egypt: Insights on Esophagogastroduodenoscopy (EGD) Utilization and Surgical Volumes’, published in Obesity Surgery. To access this paper, please click here
Reference
Quake SYL, Mohammadi-Zaniani G, Musbahi A, Old O, Courtney M, Small P. Routine use of esophago-gastro-duodenoscopy (EGD) in bariatric surgery—an international survey of our current practice. Obes Surg. 2022;32(11):3627–34. https://doi.org/10.1007/s11695-022-06252-0.