Is it Necessary to Send the Sleeve Gastrectomy Specimens to Pathology?

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has become more popular among other bariatric procedures. The histopathologic changes in the sleeve gastrectomy specimens have not been widely investigated among the Turkish population. Objective: The purpose of this study was to delineate these histopathologic findings of the LSG specimens of morbidly obese patients from a single center. Materials and Methods: A prospective database of all patients who have undergone LSG at a single center was reviewed. Demographic parameters, that is, sex, age, and body mass index were examined. The incidence of Helicobacter pylori, and other pathologic findings in the specimens were studied. Results: In total, 253 patients who had undergone LSG between the period spanning from April 2012 to January 2017 were included in the study. The 183 patients were female individuals and 70 patients were male individuals. The mean age at the time of operation was 38.5 years (range, 18 to 65 y). The mean body mass index was 47.7 kg/m2. The pathologic findings were H. pylori positivity in 69 patients (27%), chronic active gastritis in 52 patients (20.5%), chronic gastritis in 135 patients (53.4%), and intestinal metaplasia in 5 patients (2%), whereas normal histopathologic findings were observed in 65 patients (25.7%). As regards surgical complications, the mortality rate was 0%, the staple-line leak was observed in 2 patients (0.8%), and intra-abdominal hemorrhage occurred in 2 patients (0.8%). Conclusions: The majority of patients who underwent LSG had pathologic findings in the resected specimens. With regard to the high incidence of pathologic findings in this study, we conclude that it is essential to send the gastrectomy materials for pathologic investigation after sleeve gastrectomy.

Association of Hypercholesterolemia With Gastric Intestinal Metaplasia, Findings After Sleeve Gastrectomy Pathology Review

“…Therefore, premalignant lesions such as IM, severe atrophic changes, or dysplasia in the VSG specimen should be an alarm for further endoscopic follow-ups. Previous serious review of histopathologic findings after VSG revealed the prevalence of IM to be between 0.3% and 9.9% of cases 8–10,18,23–28. In our study, IM was detected in 5.3% of all specimens after VSG.…”

“…1,18 While the American Society for Gastrointestinal Endoscopy (ASGE) recommends the surveillance of IM via EGD only in the presence of gastric cancer risk factors such as Asian ancestry or a strong family history of gastric cancer, 4 many investigators recommend regular endoscopic follow-ups in all patients with IM. 18,19 In addition, the International Federation for the Surgery of Obesity (IFSO) and metabolic disorders recommend performing surveillance EGD in all patients after bariatric and metabolic surgery and then every 2 to 3 years after VSG for precocious diagnosis of lesions such as Barrett's esophagus or other premalignant findings. 20 Further, resection of the gastric remnant in Roux-en-Y gastric bypass is suggested by Raghavendra and Kini 12 since full endoscopic access and evaluation is not feasible after the procedure.…”

Histopathological findings on resected gastric specimens from obese patients undergoing laparoscopic sleeve gastrectomy

“…Histopathological examination of the resected gastric specimens revealed normal histology in 33.7% of the cases, almost equal to those published by Raess et al (35.2%) [12], but slightly higher than those published by Komaei et al [14] and Demirbas et al [15] where they found normal histology in 25.5% and 25.7% of the specimens, respectively. On the other hand, some published studies reported a higher rate of normal histology compared to our results (50.9% and 52%, respectively) [16,17].…”

“…They found active chronic gastritis in 37.1% of the cases, but intestinal metaplasia was found only in 9.9% of the cases. On the contrary, in other published studies chronic gastritis was the most encountered abnormal finding [13][14][15].…”

Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in Egyptian patients with morbid obesity

“…Routine histopathological study for gastrointestinal specimens, including LSG operations, occurs in many tertiary hospitals to confirm the samples and detect unexpected pathological abnormalities [ 24 , 34 , 35 ]. Histopathological data for SG specimens are insufficient to describe the common histopathological findings leading some authors to support the policy of routine histopathological examination of all SG specimens to detect any pathology that may have an impact on patient management [ 34 , 36 ]. Demirbas et al [ 36 ] studied 253 patients who had undergone SG showing different pathologic findings; H. pylori positivity in 27% of patients, chronic active gastritis in 20.5%, chronic gastritis in 53.4%, and intestinal metaplasia in 2%, whereas unremarkable histopathologic findings were seen in 25.7% of patients.…”