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Unexpected histopathological findings after sleeve gastrectomy

  • Adam Di Palma
  • Sultan Alhabdan
  • Azusa Maeda
  • Fabrizio Mattu
  • Runjan Chetty
  • Stefano Serra
  • Fayez Quereshy
  • Timothy Jackson
  • Allan OkrainecEmail author
2019 SAGES Oral
  • 15 Downloads

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) represents one of the most commonly performed bariatric procedures and, in contrast to the Roux-en-Y gastric bypass, produces a specimen for pathologic examination. This study aims to describe unexpected histopathological findings in order to better define preoperative management of patients undergoing LSG.

Methods

All LSG cases performed at an academic center in Toronto, Ontario between 2010 and 2017 were reviewed. All specimens underwent histopathological assessment, while those with findings suspicious for neoplasia or the presence of Helicobacter pylori underwent additional immunohistochemical stainings. Baseline patient characteristics and surgical outcomes were obtained from our internal database.

Results

A total of 222 patients underwent LSG during the study period and had their specimens examined histologically. Among them, 22.5% underwent preoperative endoscopy. The most common histopathological diagnosis was no abnormal findings (50.9%) followed by gastritis (25.7%). Abnormal findings warranting a change in postoperative management or follow-up were discovered in 8.6% of specimens and included H. pylori infection, intestinal metaplasia, malignancy, and atrophic gastritis. Only 4.7% of all patients had not undergone preoperative endoscopy and had truly unexpected findings. No significant association was found between abnormal findings and age, sex, or baseline body mass index (BMI).

Conclusions

Although a majority of patients had a gastric specimen within normal limits, 8.6% had findings requiring a change in postoperative management. This rate dropped to 4.7% when patients whose diagnoses were known preoperatively were excluded. Our findings suggest that further research is needed to better define the role of preoperative endoscopy to potentially reduce the number of unexpected findings following LSG.

Keywords

Bariatric surgery Sleeve gastrectomy Incidental finding Endoscopy Neoplasia Helicobacter pylori 

Notes

Funding

This study received no outside financial support.

Compliance with ethical standards

Disclosures

Dr. Di Palma reports grants from Medtronic outside the submitted work. Dr. Okrainec reports personal fees from Medtronic, personal fees from Ethicon, personal fees from Merck, outside the submitted work. Drs. Alhabdan, Maeda, Mattu, Chetty, Serra, Quereshy and Jackson have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    NIH conference (1991) Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 115:956-961Google Scholar
  2. 2.
    Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. The Cochrane database of systematic reviews:CD003641Google Scholar
  3. 3.
    English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM (2018) American society for metabolic and bariatric surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis 14:259–263CrossRefGoogle Scholar
  4. 4.
    Almazeedi S, Al-Sabah S, Al-Mulla A, Al-Murad A, Al-Mossawi A, Al-Enezi K, Jumaa T, Bastaki W (2013) Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg 23:314–319CrossRefGoogle Scholar
  5. 5.
    Raess PW, Baird-Howell M, Aggarwal R, Williams NN, Furth EE (2015) Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Relat Dis 11:1020–1023CrossRefGoogle Scholar
  6. 6.
    Clapp B (2015) Histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS 19(e2013):00259Google Scholar
  7. 7.
    Ohanessian SE, Rogers AM, Karamchandani DM (2016) Spectrum of gastric histopathologies in severely obese American patients undergoing sleeve gastrectomy. Obes Surg 26:595–602CrossRefGoogle Scholar
  8. 8.
    Miller GC, Reid AS, Brown IS (2016) The pathological findings seen in laparoscopic sleeve gastrectomies for weight loss. Pathology 48:228–232CrossRefGoogle Scholar
  9. 9.
    Kinsinger LA, Garber JC, Whipple O (2016) A review of sleeve gastrectomy specimen histopathology. Am Surg 82:1101–1104Google Scholar
  10. 10.
    Lauti M, Gormack SE, Thomas JM, Morrow JJ, Rahman H, MacCormick AD (2016) What does the excised stomach from sleeve gastrectomy tell us? Obes Surg 26:839–842CrossRefGoogle Scholar
  11. 11.
    AbdullGaffar B, Raman L, Khamas A, AlBadri F (2016) Should we abandon routine microscopic examination in bariatric sleeve gastrectomy specimens? Obes Surg 26:105–110CrossRefGoogle Scholar
  12. 12.
    Safaan T, Bashah M, El Ansari W, Karam M (2017) Histopathological changes in laparoscopic sleeve gastrectomy specimens: prevalence, risk factors, and value of routine histopathologic examination. Obes Surg 27:1741–1749CrossRefGoogle Scholar
  13. 13.
    Dogan U, Suren D, Oruc MT, Gokay AA, Mayir B, Cakir T, Aslaner A, Oner OZ, Bulbuller N (2017) Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy. Eur Rev Med Pharmacol Sci 21:5430–5436Google Scholar
  14. 14.
    Aljerian K (2018) Histopathological findings in laparoscopic sleeve gastrectomy specimens from patients with obesity in Saudi Arabia. Gastroenterol Res Pract 2018:1702705CrossRefGoogle Scholar
  15. 15.
    Oner RI, Ozdas S (2018) Histopathological findings in morbid obese patients undergoing laparoscopic sleeve gastrectomy: does H. pylori infection effective on pathological changes? Obes Surg 28:3136–3141CrossRefGoogle Scholar
  16. 16.
    Yardimci E, Bozkurt S, Baskoy L, Bektasoglu HK, Gecer MO, Yigman S, Akbulut H, Coskun H (2018) Rare entities of histopathological findings in 755 sleeve gastrectomy cases: a synopsis of preoperative endoscopy findings and histological evaluation of the specimen. Obes Surg 28:1289–1295CrossRefGoogle Scholar
  17. 17.
    Peker KD, Sahbaz NA, Seyit H, Kones O, Gumusoglu AY, Alis H (2017) An alternative view on the necessity of EGD before sleeve gastrectomy. Surg Obes Relat Dis 13:1959–1964CrossRefGoogle Scholar
  18. 18.
    Salama A, Saafan T, El Ansari W, Karam M, Bashah M (2018) Is routine preoperative esophagogastroduodenoscopy screening necessary prior to laparoscopic sleeve gastrectomy? Review of 1555 cases and comparison with current literature. Obes Surg 28:52–60CrossRefGoogle Scholar
  19. 19.
    Asge Standards of Practice C, Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, Dominitz JA, Harrison ME, Ikenberry SO, Jagannath SB, Lichtenstein, Shen B, Lee KK, Van Guilder T, LE Stewart (2008) Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 68:1–10CrossRefGoogle Scholar
  20. 20.
    Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American association of clinical endocrinologists, the obesity society, and American society for metabolic & bariatric surgery. Surg Obes Relat Dis 9:159–191CrossRefGoogle Scholar
  21. 21.
    Hartin CW Jr, ReMine DS, Lucktong TA (2009) Preoperative bariatric screening and treatment of Helicobacter pylori. Surg Endosc 23:2531–2534CrossRefGoogle Scholar
  22. 22.
    Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, Malfertheiner P, Graham DY, Wong VWS, Wu JCY, Chan FKL, Sung JJY, Kaplan GG, Ng SC (2017) Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 153:420–429CrossRefGoogle Scholar
  23. 23.
    Brownlee AR, Bromberg E, Roslin MS (2015) Outcomes in patients with Helicobacter pylori undergoing laparoscopic sleeve gastrectomy. Obes Surg 25:2276–2279CrossRefGoogle Scholar
  24. 24.
    Rath-Wolfson L, Varona R, Bubis G, Tatarov A, Koren R, Ram E (2017) Gastritis in patients undergoing sleeve gastrectomy: prevalence, ethnic distribution, and impact on glycemic. Medicine (Baltimore) 96:e6602CrossRefGoogle Scholar
  25. 25.
    Rossetti G, Moccia F, Marra T, Buonomo M, Pascotto B, Pezzullo A, Napolitano V, Schettino P, Avellino M, Conzo G, Amato B, Docimo G, Tolone S, Del Genio G, Docimo L, Fei L (2014) Does helicobacter pylori infection have influence on outcome of laparoscopic sleeve gastrectomy for morbid obesity? Int J Surg 12(Suppl 1):S68–S71CrossRefGoogle Scholar
  26. 26.
    Lee YC, Chiang TH, Chou CK, Tu YK, Liao WC, Wu MS, Graham DY (2016) Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology 150(1113–1124):e1115Google Scholar
  27. 27.
    Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, Haruma K, Asaka M, Uemura N, Malfertheiner P, Faculty Members of Kyoto Global Consensus C (2015) Kyoto global consensus report on Helicobacter pylori gastritis. Gut 64:1353–1367CrossRefGoogle Scholar
  28. 28.
    Blackstein ME, Blay JY, Corless C, Driman DK, Riddell R, Soulieres D, Swallow CJ, Verma S, Canadian Advisory Committee on GIST (2006) Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol 20:157–163CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Adam Di Palma
    • 1
  • Sultan Alhabdan
    • 1
  • Azusa Maeda
    • 1
  • Fabrizio Mattu
    • 2
  • Runjan Chetty
    • 2
    • 3
  • Stefano Serra
    • 2
    • 3
  • Fayez Quereshy
    • 1
    • 4
  • Timothy Jackson
    • 1
    • 4
  • Allan Okrainec
    • 1
    • 4
    • 5
    Email author
  1. 1.Division of General SurgeryUHNTorontoCanada
  2. 2.Department of PathologyUHNTorontoCanada
  3. 3.Department of Laboratory Medicine and Pathology, Faculty of MedicineUniversity of TorontoTorontoCanada
  4. 4.Department of Surgery, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Toronto Western Hospital, University Health NetworkTorontoCanada

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