{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:30:32Z","timestamp":1777447832231,"version":"3.51.4"},"reference-count":10,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Obesity is a known risk factor for gastroesophageal reflux disease (GERD). Morbidly obese patients in rural areas are usually referred to the local surgeon for endoscopic evaluation. This situation poses significant challenges given the increased risk for perioperative complications due to anatomical and metabolic factors. This study aims to evaluate the safety of performing GERD diagnostic workup studies in a rural setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Institutional review board approval was obtained for a retrospective chart review of patients who presented with GERD symptoms to a rural antireflux clinic between August 2015 and October 2020. Patients were included if their body mass index (BMI) was over 35 with comorbidities or over 40\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      who underwent upper gastrointestinal endoscopy with or without concomitant placement of wireless pH probe and\/or functional luminal imaging probe.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 117 patients met the inclusion criteria. There were 94 (80.3%) females and 23(19.7%) males. The average age was 56.0 \u00b1 13.4\u00a0years. The average BMI was 40.4 (35-66.4). Proton pump inhibitor use was noted in 97\/117 (82.9%) with an average duration of 12.0 \u00b1 9.2\u00a0years. The average GERD-Health Related Quality of Life, Reflux Symptom Index and GERD Symptom Score (GERSS) were 29.8 \u00b1 20, 24.5 \u00b1 14.2 and 21.3 \u00b1 15.4 respectively. There were no procedural complications. All the endoscopic examinations were successfully completed and patients were discharged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Performing diagnostic studies for GERD for morbidly obese patients in critical access hospitals is safe. Patient selection, proper training and adequate preparation are critical prerequisites for good outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0003134821998677","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T10:30:44Z","timestamp":1614249044000},"page":"1293-1297","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Advanced Endoscopic Evaluation of Gastroesophageal Reflux Disease in Morbidly Obese Patients in a Rural Setting"],"prefix":"10.1177","volume":"88","author":[{"given":"Medhat","family":"Fanous","sequence":"first","affiliation":[{"name":"Department of Surgery, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Surgery, Twin County Regional Healthcare, Galax, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lorenson","sequence":"additional","affiliation":[{"name":"Surgical Services, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamison","family":"Gould","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"bibr1-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2016.02.008"},{"key":"bibr2-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1177\/000313481808400714"},{"key":"bibr3-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2016.03.001"},{"key":"bibr4-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1177\/0003134820921181"},{"key":"bibr5-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-020-0749-7"},{"key":"bibr6-0003134821998677","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9185.125707"},{"key":"bibr7-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes471"},{"key":"bibr8-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2013.11.009"},{"key":"bibr9-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.01.049"},{"key":"bibr10-0003134821998677","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(92)70564-1"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0003134821998677","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0003134821998677","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0003134821998677","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:35:56Z","timestamp":1777379756000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0003134821998677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":10,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1177\/0003134821998677"],"URL":"https:\/\/doi.org\/10.1177\/0003134821998677","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]}}}