1
|
Heiat M, Javanbakht M, Abyazi MA, Modarresi F, Gholizadeh H. How reliable is pre-sleeve endoscopy to characterize pathological features? Ann Diagn Pathol 2024; 72:152319. [PMID: 38657494 DOI: 10.1016/j.anndiagpath.2024.152319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Vertical sleeve gastrectomy is a relatively new bariatric procedure with lower morbidity and mortality than other weight loss surgeries. The predictive values of preoperative esophagogastroduodenoscopy for detecting histopathological abnormalities prior to sleeve gastrectomy have not been clearly described. This study aimed to determine the negative predictive value of preoperative endoscopic biopsies for detecting Helicobacter pylori (H. pylori) infection and other pathological findings. METHODS This cross-sectional study examined 102 patients who underwent vertical sleeve gastrectomy from January 2023 to November 2023. Preoperative histopathology of esophagogastroduodenoscopy specimens was compared to postoperative ones for H. pylori infection, gastritis, atrophy, and metaplasia. Moreover, gastroesophageal reflux disease symptoms were postoperatively followed for 6 months. RESULTS The negative predictive value of preoperative esophagogastroduodenoscopy for detecting H. pylori infection, gastritis, metaplasia and atrophy were 95 %, 79 %, 93 %, and 98 %, respectively. In an overall view, for all pathologies, the negative predictive value was 53.4 %. Moderate gastritis and focal metaplasia were significantly underdiagnosed preoperatively (p < 0.001). H. pylori infection and focal metaplasia were significantly more prevalent in females after surgery (p < 0.001). H. pylori infection and gastritis were positively correlated with increased postoperative gastroesophageal reflux disease symptoms (p < 0.001). CONCLUSION Preoperative endoscopy has a high negative predictive value for detecting H. pylori infection, atrophy, and metaplasia but has suboptimal values for gastritis.
Collapse
Affiliation(s)
- Mohammad Heiat
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Clinical Science Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Abyazi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farrokh Modarresi
- Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamed Gholizadeh
- Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
Abokhozima A, Zidan MH, Altabbaa H, Abo Elmagd A, Alokl M, Fathy F, Amgad A, Al Shaqran O, Eissa MH, Selim A. Can Incidental Gastric GISTs During Bariatric Surgeries Change the Primary Plan of Surgery? A Single Team Experience and a Systematic Review of Literature. Obes Surg 2024; 34:2186-2197. [PMID: 38684584 PMCID: PMC11127811 DOI: 10.1007/s11695-024-07224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy.
Collapse
Affiliation(s)
- Ahmed Abokhozima
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| | - Mohamed H Zidan
- Alexandria Main University Hospital, Alexandria University, AlexandriaAlexandria, 5372066, Egypt.
- Alexandria University, Alexandria, 21526, Egypt.
- Ekbal Hospital, Alexandria, Egypt.
| | | | - Ahmed Abo Elmagd
- Alexandria Main University Hospital, Alexandria University, AlexandriaAlexandria, 5372066, Egypt
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| | - Mohammed Alokl
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| | | | - Ahmed Amgad
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | | | - Aliaa Selim
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| |
Collapse
|
3
|
Rudasill J, Peeler C, Grant D, Lazar C, Criswell SL. A comparison of staining methods for Helicobacter pylori in laparoscopic vertical sleeve gastrectomy resections. Lab Med 2024; 55:386-390. [PMID: 38048075 DOI: 10.1093/labmed/lmad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Helicobacter pylori is an important public health concern due to its status as a carcinogenic bacterium. Well adapted to the acidic environment of the human stomach, the variety of strains and virulence factors of the organism when interacting with the host immune system creates an individualistic response. Although estimates suggest that approximately half of the global population is infected with H pylori, the majority of infected persons remain asymptomatic while harboring an increased risk of intestinal metaplasia and gastric cancers. Therefore, appropriate diagnostic testing protocols are imperative. METHODS This study compared labeling methodologies, including Wright stain, alcian yellow toluidine blue (AYTB), and immunohistochemistry (IHC) on formalin-fixed paraffin-embedded stomach resections from sleeve gastrectomy patients, to detect H pylori infection. RESULTS Although all 3 labeling methods evidenced similar specificity in H pylori detection, the IHC method was significantly more sensitive. However, the IHC cost per test was approximately 5-fold higher than that of the Wright or AYTB stains, and the technical time required per test was at least 6-fold that of Wright or AYTB. CONCLUSION Despite the higher cost per test, IHC is the most sensitive and preferred method for determination of H pylori infection.
Collapse
Affiliation(s)
- JoAnna Rudasill
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Chelsea Peeler
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Danielle Grant
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| | - Cynthia Lazar
- Department of Pathology, Methodist University Hospital, Memphis, TN, US
| | - Sheila L Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, US
| |
Collapse
|
4
|
Owen CK, Felinski MM, Bajwa KS, Walker PA, Mehta SS, Wilson EB, Boodoo S, Kudav V, Akhtar SJ, Shah SK, Kling ME. Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience. Obes Surg 2024; 34:1442-1448. [PMID: 38472705 DOI: 10.1007/s11695-024-07155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Endoscopy prior to bariatric surgery is not always performed, and in sleeve gastrectomy (SG), the surgical specimen is not always sent for pathological examination. There is limited data on the frequency of clinically significant findings in SG specimens or correlation with preoperative endoscopy. METHODS We reviewed 426 consecutive SG patients to determine the concordance of preoperative endoscopy findings in patients with clinically significant postoperative pathology. RESULTS Preoperative endoscopy was performed on 397 patients (93.2%). Three hundred seventy-three patients had preoperative endoscopy and surgical pathology results available. Then, 20/373 (5.4%) patients had potentially significant postoperative pathology, including intestinal metaplasia, autoimmune metaplastic atrophic gastritis (AMAG), gastrointestinal stromal tumors, and/or gastric cancer. The overall incidence of AMAG in the entire cohort was 2.3%. Preoperative gastric biopsies (to include gastric body) identified AMAG in nearly 1/2 of patients. Patients with clinically significant postoperative pathology results had a median [interquartile range] of 3 [3-5] tissue blocks examined as compared to 3 [1-3] for the remainder of the cohort (p < 0.001). CONCLUSION This is one of the largest studies describing clinically significant postoperative pathology after SG. AMAG, in particular, is of particular importance as it is associated with a 3-fivefold increase in risk for gastric cancer. The incidence of significant postoperative pathology in this population is small but potentially clinically significant and requires validation in larger studies. We recommend wider sampling in preoperative endoscopy (body and antrum), especially in patients being planned for gastric bypass, consideration for routine pathological examination of SG surgical specimens, with careful gross examination and targeted sampling.
Collapse
Affiliation(s)
- Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Melissa M Felinski
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kulvinder S Bajwa
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peter A Walker
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Vishal Kudav
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shaan J Akhtar
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA.
| | - M Elaine Kling
- Brown and Associates Medical Laboratories, Sugar Land, TX, USA
| |
Collapse
|
5
|
Grant D, Peeler C, Rudasill J, Lazar C, Bodkin A, Criswell SL. The presence of H. pylori in laparoscopic sleeve gastrectomy specimens is associated with increased mucosal thickness, presence of secondary follicles, increased chronic inflammation, and intestinal metaplasia. J Histotechnol 2024; 47:5-12. [PMID: 37823587 DOI: 10.1080/01478885.2023.2265601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Helicobacter pylori is putatively present in over half of the global human population and is recognized as a carcinogenic agent that increases the likelihood of infected patients developing gastric adenocarcinoma or gastric lymphoma. Although there are several means for testing for H. pylori, the gold standard remains the invasive histologic evaluation. The current most popular form of bariatric surgery is the laparoscopic sleeve gastrectomy (LSG) and is the only bariatric surgery which supplies a specimen for histologic evaluation. While non-invasive testing is effective in diagnosing and monitoring H. pylori infection, histological examination of biopsies and resections is the only way to grade chronic inflammation and evaluate specimens for additional pathologies such as intestinal metaplasia. The investigators evaluated 203 sequential LSG specimens collected from a major metropolitan hospital over the period of one year. Specimens were processed to paraffin, stained with hematoxylin and eosin, alcian blue, and immunohistochemistry to determine the presence of H. pylori, chronic inflammation, presence of secondary lymphoid follicles in the mucosa, mucosal thickness, and presence of intestinal metaplasia. Statistical analyses demonstrated a significant positive correlation among all factors examined. The overall positivity rate of H. pylori in LSG specimens was 18.2% but ranged from 6.9-23.8% depending on whether the treating clinician performed routine pre-surgical endoscopy. The presence of H. pylori was associated with a higher average chronic inflammation grade, intestinal metaplasia, thicker mucosa, and presence of lymphoid follicles with germinal centers in the mucosa.
Collapse
Affiliation(s)
- Danielle Grant
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chelsea Peeler
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - JoAnna Rudasill
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cynthia Lazar
- Department of Pathology, Methodist University Hospital, Memphis, TN, USA
| | - Amanda Bodkin
- Department of Pathology, Methodist Le Bonheur Germantown Hospital, Germantown, TN, USA
| | - Sheila L Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
6
|
El Nakeeb A, Salem A, El Sorogy M, Elrefai M, Rashad AE, Sewefy AM, Kayed T, Mohammed MM, Zaid A, Aldossary HM, Dabobash MD, Sboui K, Attia M. Impact of Helicobacter pylori Status on Postoperative Morbidities After Laparoscopic Sleeve Gastrectomy in an Endemic Region (a Retrospective Multicentric Study). Obes Surg 2024; 34:183-191. [PMID: 37989926 DOI: 10.1007/s11695-023-06961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Studies are still ongoing to determine whether Helicobacter pylori (HP) may affect the results of laparoscopic sleeve gastrectomy (LSG). The main research objectives were HP prevalence in patients with severe obesity and the effects of HP status on outcomes. PATIENTS AND METHODS This multicenter retrospective study included patients with severe obesity who had LSG. The patients were grouped into three groups based on the HP status of preoperative endoscopic biopsies and postoperative specimen results: group I (negative HP), group II (eradicated HP), and group III (positive HP). The primary outcome was the overall postoperative morbidities. RESULTS One thousand six hundred fifteen patients who underwent LSG for severe obesity were included in this study. Seven hundred fifty (46.4%) patients had negative HP, and 637 (39.4%) patients had eradicated HP, whereas 228 (14.1%) patients had positive HP. The antral and gastric body wall thickness was significantly noticed with positive HP. The groups had no significant differences regarding postoperative complication frequency, severity, and hospital mortality. The rates of gastric leakage in the three groups do not differ significantly. BMI > 50, gastropexy, gastric thickness, and antral resection were found to be independent risk factors for the occurrence of postoperative complications after LSG. There was no statistical significance as regards postoperative %TWL and %EWL among the three groups. CONCLUSION The early results of LSG do not appear to be impacted by HP's status. The early postoperative course is unaffected by HP eradication anymore. Therefore, routine preoperative HP testing may not be as necessary, and management can be finished after LSG.
Collapse
Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt.
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia.
| | - Ali Salem
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed El Sorogy
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Mohamad Elrefai
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| | - Aly E Rashad
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | | | - Taha Kayed
- Minia University Hospital, Minya, 61519, Egypt
| | | | - Ahmed Zaid
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | | | - Mahmoud D Dabobash
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | - Kalthoum Sboui
- Wadi Aldawaser Armed Forces Hospital, 18511, Wadi Aldawaser, Saudi Arabia
| | - Mohamed Attia
- Gastroenterology Surgical Center 1 Mansoura University, Mansoura, 35516, Egypt
| |
Collapse
|
7
|
Krzysiek-Maczka G, Brzozowski T, Ptak-Belowska A. Helicobacter pylori-activated fibroblasts as a silent partner in gastric cancer development. Cancer Metastasis Rev 2023; 42:1219-1256. [PMID: 37460910 PMCID: PMC10713772 DOI: 10.1007/s10555-023-10122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/20/2023] [Indexed: 12/18/2023]
Abstract
The discovery of Helicobacter pylori (Hp) infection of gastric mucosa leading to active chronic gastritis, gastroduodenal ulcers, and MALT lymphoma laid the groundwork for understanding of the general relationship between chronic infection, inflammation, and cancer. Nevertheless, this sequence of events is still far from full understanding with new players and mediators being constantly identified. Originally, the Hp virulence factors affecting mainly gastric epithelium were proposed to contribute considerably to gastric inflammation, ulceration, and cancer. Furthermore, it has been shown that Hp possesses the ability to penetrate the mucus layer and directly interact with stroma components including fibroblasts and myofibroblasts. These cells, which are the source of biophysical and biochemical signals providing the proper balance between cell proliferation and differentiation within gastric epithelial stem cell compartment, when exposed to Hp, can convert into cancer-associated fibroblast (CAF) phenotype. The crosstalk between fibroblasts and myofibroblasts with gastric epithelial cells including stem/progenitor cell niche involves several pathways mediated by non-coding RNAs, Wnt, BMP, TGF-β, and Notch signaling ligands. The current review concentrates on the consequences of Hp-induced increase in gastric fibroblast and myofibroblast number, and their activation towards CAFs with the emphasis to the altered communication between mesenchymal and epithelial cell compartment, which may lead to inflammation, epithelial stem cell overproliferation, disturbed differentiation, and gradual gastric cancer development. Thus, Hp-activated fibroblasts may constitute the target for anti-cancer treatment and, importantly, for the pharmacotherapies diminishing their activation particularly at the early stages of Hp infection.
Collapse
Affiliation(s)
- Gracjana Krzysiek-Maczka
- Department of Physiology, the Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531, Kraków, Poland.
| | - Tomasz Brzozowski
- Department of Physiology, the Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531, Kraków, Poland.
| | - Agata Ptak-Belowska
- Department of Physiology, the Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531, Kraków, Poland
| |
Collapse
|
8
|
Paşaoğlu HE, Özcan TB, Öztürk Ç, Çelik E, Şavlı TB, Vartanoğlu T. Histopathological Findings in Turkish Patients Undergoing Sleeve Gastrectomy: Is Histopathologic Examination of Sleeve Gastrectomy Specimens Clinically Important? Obes Surg 2023; 33:2808-2815. [PMID: 37474865 DOI: 10.1007/s11695-023-06728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Sleeve gastrectomy (SG) is a widely used surgical method in the treatment of obesity. This study aimed to reveal the histopathological changes in SG materials and to investigate the prevalence of clinically important lesions requiring follow-up. MATERIALS AND METHODS Three hundred five patients' data who underwent SG were analyzed. Cases were divided into three groups as normal, chronic inactive gastritis (CIG), and chronic active gastritis (CAG). Age, gender, and body mass index (BMI) of the three groups and the differences in the gastritis parameters of CIG and CAG groups were compared. RESULTS Thirty-three patients (10.8%) were in the normal group, 145 (47.5%) were in the CIG group, and 127 (41.6%) were in the CAG group. Preoperative endoscopic examination was performed in all cases, but Helicobacter pylori (HP) treatment was not applied. HP were detected in 39.3%, atrophy in 3.9%, intestinal metaplasia (IM) in 4.9%, and lymphoid follicle (LF) in 30% of the cases. Inflammation, atrophy, IM, LF, and HP were significantly higher in the CAG group. The proton pump inhibitor (PPI)-related changes were seen in 20 cases and it was more frequent in the CIG group. Intramucosal signet ring cell carcinoma was detected in 1 case. Endocrine cell hyperplasia and dysplasia were present in 7 cases with CAG. Multiple grade 1 neuroendocrine tumors were detected in just 1 case. CONCLUSION In our SG specimens, HP and clinically important lesions were significantly higher in the CAG group. Pathological examination should be carefully done as the lesions detected in SG specimens can change patient management.
Collapse
Affiliation(s)
- Hüsniye Esra Paşaoğlu
- Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey.
| | - Tevhide Bilgen Özcan
- Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Çiğdem Öztürk
- Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey
- Pathology Department, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Elif Çelik
- Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey
- Pathology Department, Mardin State Hospital, Mardin, Turkey
| | - Tuğçe Bölme Şavlı
- Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey
- Pathology Department, Gaziantep Cengiz Gökçek Maternity and Children's Hospital, Gaziantep, Turkey
| | - Talar Vartanoğlu
- Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey
- General Surgery Department, Istanbul Gaziosmanpasa Medical Park Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Mousavi Naeini SM, Toghraee MM, Malekpour Alamdari N. Safety and Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass Surgery on Obese Patients with Type II Diabetes Mellitus during a One-Year Follow-up Period: A Single Center Cohort Study. ARCHIVES OF IRANIAN MEDICINE 2023; 26:365-369. [PMID: 38301094 PMCID: PMC10685819 DOI: 10.34172/aim.2023.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/06/2022] [Indexed: 02/03/2024]
Abstract
BACKGROUND We aimed to evaluate the safety and efficacy of single anastomosis sleeve ileal (SASI) bypass surgery on obese patients with type II diabetes mellitus during a one-year follow-up period. METHODS We included patients with a body mass index (BMI) more than 35 kg/m2 and at least one-year history of type II diabetes mellitus. We excluded patients aged under 25 or above 66 years, those who were not candidates for surgery, needed another bariatric surgery, and those not willing to participate in the study. All the patients were visited in the outpatient office on the 10th and 45th days as well as the 3rd month of the post-operative period until the end of the first year. RESULTS in this study, we investigated 14 male (23.0%) and 47 female (77.0%) morbidly obese patients with type II diabetes mellitus who underwent SASI bypass. The mean excess weight loss (%EWL) was 60.99±15.69 and the mean total weight loss (%TWL) was 30.39±6.52 at the end of the one-year follow up. Finally, 44 patients (72.1%) had a complete and 15 patients (24.6%) had partial remission of type II diabetes mellitus. Of note, severe complications were recorded in two patients (3.2%). Paired t test analysis demonstrated a significant decrease for fasting plasma sugar (FBS) after one-year follow-up in comparison with FBS before surgery (P<0.0001). Furthermore, this difference was observed in HbA1c (P<0.0001). CONCLUSION SASI bypass is an effective method for weight loss and controlling type II diabetes mellitus.
Collapse
Affiliation(s)
| | - Mir Mohsen Toghraee
- Department of General Surgery, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Malekpour Alamdari
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Yang J, Trivedi A, Nyirenda T, Shi M, Petit R, Talishinskiy T. Histopathologic findings in laparoscopic sleeve gastrectomy: is routine full pathologic evaluation indicated? Surg Obes Relat Dis 2023; 19:283-288. [PMID: 36372693 DOI: 10.1016/j.soard.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric surgery. The resected gastric segment is routinely sent for pathology evaluation. No formal national recommendation exists that mandates pathology review. We proposed to study the largest histopathologic series in SG patients yet reported. OBJECTIVE The primary objective of our study was to determine whether a subgroup of patients who underwent bariatric surgery in the northeastern Unites States is more susceptible to having clinically significant pathologic findings that may benefit from routine histopathologic evaluation of the gastric sleeve specimen. SETTING University hospital. METHODS A retrospective electronic chart review of patients who underwent SG at a single large academic institution was performed. Patient demographics, body mass index, and histopathologic reports of the gastric specimens obtained during SG were analyzed. RESULTS The records of 3543 patients were reviewed. A total of 1076 patients had abnormal pathologies, including gastritis (938), follicular gastritis (98), intestinal metaplasia (25), gastrointestinal stromal tumor (12), leiomyoma (1), lymphoma (1), and other malignancy (1). Black and Hispanic patients had a higher incidence of developing gastrointestinal stromal tumor and intestinal metaplasia. A higher incidence of Helicobacter pylori infection among specimens with abnormal pathologies was noted. CONCLUSIONS The findings of this study call into question the routine use of pathology workup in gastric specimens after SG. Our data suggest that such analysis may be warranted in certain subtypes of patients such as older Black and Hispanic patients in the northeastern United States.
Collapse
Affiliation(s)
- James Yang
- St. Joseph's University Medical Center, Paterson, New Jersey.
| | - Aakash Trivedi
- St. Joseph's University Medical Center, Paterson, New Jersey
| | - Themba Nyirenda
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Meiyi Shi
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Ryan Petit
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Toghrul Talishinskiy
- St. Joseph's University Medical Center, Paterson, New Jersey; Hackensack University Medical Center, Hackensack, New Jersey
| |
Collapse
|
11
|
Alessandris R, Moroso F, Michelotto M, Fassan M, Angerilli V, Callegari L, Foletto M. Preoperative endoscopy and pathology report of the specimen to be recommended in sleeve gastrectomy? Pathologica 2023; 115:90-96. [PMID: 37017300 PMCID: PMC10463000 DOI: 10.32074/1591-951x-781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 04/06/2023] Open
Abstract
Objective Preoperative upper gastrointestinal endoscopy (UGIE) and postoperative histopathological examination (HPE) of resected specimens are still controversial issues in bariatric surgery. Methods A retrospective review of prospectively collected laparoscopic sleeve gastrectomies (SG) performed at our institution for morbid obesity was carried out. All patients underwent pre-operative UGIE with biopsy, post-operative HPE and conventional post-operative follow-up. Results From January 2019 through January 2021 we performed a total of 501 laparoscopic SG. A total of 12 (2.4%) neoplasms were found, 2 evident at preoperative UGIE, 4 detected during operation, and 6 at HPE. Eight of these 12 cases had some malignant potential and 5 would not have been detected without HPE of the specimen. The most significant unexpected case was a fundic gland type adenocarcinoma in a 64-year-old female with severe obesity. Conclusion On the basis of our clinical experience, we recommend both preoperative endoscopic assessment and postoperative HPE of the specimen to provide the best available treatment to these patients.
Collapse
Affiliation(s)
- Remo Alessandris
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Federico Moroso
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Mauro Michelotto
- Surgical Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Valentina Angerilli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Linda Callegari
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Mirto Foletto
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| |
Collapse
|
12
|
Quinino RME, Barbosa ALC, de Araújo Barros Xavier M, de Lima França R, de Freitas MPC, Goldenberg A. Analysis of the Immunohistochemical Expression of Ghrelin in the Gastric Mucosa and Correlation with Weight Loss After Sleeve Gastrectomy. Obes Surg 2022; 32:3687-3695. [PMID: 36151347 DOI: 10.1007/s11695-022-06286-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sleeve gastrectomy is one of the main techniques used to treat severe obesity. The study of the immunohistochemical expression of ghrelin in the gastric mucosa has already been related to weight loss and can be a promising method to predict the surgical outcome. PURPOSE To analyze the immunohistochemical expression of ghrelin in the gastric mucosa and its correlation with weight loss, comorbidities, and inflammatory changes after sleeve gastrectomy. METHODS Thirty-five patients submitted to sleeve gastrectomy were evaluated, 29 of whom were female (82.9%), with a mean age of 35.2 years and an average body mass index of 38.1 kg/m2. Endoscopic samples of the mucosa were collected, whose ghrelin expression was evaluated in a semi-quantitative way through the stained antibody area. These data were correlated with weight loss at 3, 6, and 12 months and with the control of comorbidities, and inflammatory alterations. RESULTS The average total weight loss (TWL%) was 17.7, 26.4, and 32.1%, respectively, at 3, 6, and 12 months. A negative correlation was found between the immunohistochemical expression of ghrelin in the endoscopic biopsy of the fundus and weight loss at 3 (s = - 0.536; p = 0.001) and 6 months (s = - 0.339; p = 0.047). CONCLUSION The immunohistochemical expression of ghrelin in the mucosa of the gastric fundus was negatively correlated with early weight loss after sleeve gastrectomy.
Collapse
Affiliation(s)
- Reynaldo Martins E Quinino
- Department of Integrated Medicine at the Universidade Federal Do Rio Grande Do Norte, Rua Raimundo Chaves 1652, Casa i 13 Natal, Candelária, RN, 59064-390, Brazil. .,Department of Digestive System Surgery at Hospital, Universitário Onofre Lopes, Av. Nilo Peçanha, 620 Natal, Petrópolis, RN, 59012-300, Brazil.
| | - André Luis Costa Barbosa
- Surgery Service for Obesity and Associated Diseases at Hospital, Universitário Onofre Lopes, Av. Nilo Peçanha, 620 Natal, Petrópolis, RN, 59012-300, Brazil
| | | | - Romero de Lima França
- Hospital Universitário Onofre Lopes, Av. Nilo Peçanha, 620 Natal, Petrópolis, RN, 59012-300, Brazil
| | | | - Alberto Goldenberg
- Department of Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, R. Napoleão de Barros, 715 Vila Clementino, São Paulo, SP, 04024-002, Brazil
| |
Collapse
|
13
|
Kermansaravi M, Rezvani M, Elmi Sadr F, Valizadeh R, Kabir A, Pazouki A. Association of Hypercholesterolemia With Gastric Intestinal Metaplasia, Findings After Sleeve Gastrectomy Pathology Review. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:549-553. [PMID: 36130718 DOI: 10.1097/sle.0000000000001097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/31/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND We evaluated the relationship between comorbidities associated with obesity, body mass index (BMI), and development of intestinal metaplasia (IM) after vertical sleeve gastrectomy (VSG). MATERIALS AND METHODS All VSG specimens performed at an academic center between 2011 and 2018 were reviewed. All specimens underwent histopathologic assessment, while those with findings suspicious for IM underwent additional immunohistochemical work up. Baseline patient characteristics and demographic data were obtained from Iran National Obesity Surgery Database by retrospective review. RESULTS A total of 862 adult individuals underwent VSG during the study period and specimens were histopathologically examined. All patients had preoperative upper endoscopy. The most common histopathologic diagnosis was miscellaneous findings (57.8%) followed by no pathologic finding (36.7%). The minority of patients (5.5%) had IM. Although 40.5% of patients had positive Helicobacter pylori infection preoperatively, just 13.8% had still positive infection postoperatively. A significant association was found between IM and hypercholesterolemia (odds ratio: 1.95; 95% confidence interval: 1.1, 3.5). CONCLUSION This study found a correlation between histopathologic changes in patients with IM and hypercholesterolemia. Prospective research studies are recommended to further examine this correlation.
Collapse
Affiliation(s)
- Mohammad Kermansaravi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Research Center, School of Medicine
| | | | | | - Rohollad Valizadeh
- Minimally Invasive Surgery Research Center.,Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center
| | - Abdolreza Pazouki
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Research Center, School of Medicine
| |
Collapse
|
14
|
Preoperative Assessment of Patients Undergoing Bariatric Sleeve Gastrectomy: A Cross-Sectional Study. Gastroenterol Res Pract 2022. [DOI: 10.1155/2022/3622119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Saudi Arabia (SA) is one of the top countries in the world when it comes to the number of bariatric procedures performed each year. There is still some debate on whether to do regular or selective upper endoscopy during the preoperative examination. The purpose of this study was to explore various endoscopic findings and Helicobacter pylori (HP) infection in symptomatic and asymptomatic patients having laparoscopic sleeve gastrectomy (LSG) prior to surgery. Methods. We investigated a cohort of 132 patients referred to the endoscopy unit from the bariatric surgery outpatient clinic for prebariatric esophagogastroduodenoscopy (EGD) as a part of preoperative LSG. Data extraction from medical records included clinical data such as body mass index (BMI), gastrointestinal symptoms (that include heartburn, regurgitation, epigastric pain, and nausea), medical comorbidities, and laboratory investigations. It included data about the endoscopic findings of EGD procedure as esophageal, gastric, and duodenal findings results as well as the results of biopsy specimens that were taken. Results. Out of 132 patients, 29 (22%) had a BMI of less than 40 kg/m2 whereas 103 (78%) had a BMI of 40 kg/m2 or above, with an average of
kg/m2. The average age of participants was
years. HP was detected in 36 patients (35.0%) with a slightly greater prevalence in patients with a higher BMI (33.7%) than in patients with lower BMI (35.0%). Collectively, 73 patients (55.7%) had positive endoscopic findings of various grades, sites, and combinations. Incompetent cardia (35.6%) was the most often seen esophageal finding, antral gastritis (34.1%) was the most frequently encountered gastric finding, and duodenitis 1st part was the commonest duodenal endoscopic finding (7.8%). Among asymptomatic patients, incompetent cardia was detected in 33.3%, antral gastritis was found in 30.1%, and around one-quarter of them were positive on HP testing (26.6%). Additionally, 16.1% of them had signs of reflux esophagitis, 17.2% had hiatal hernia, and 14.0% had nodular gastritis. Conclusion. The current study revealed a high prevalence of positive endoscopic findings as well as HP infection upon routine endoscopic examination among patients undergoing bariatric surgery even those who were asymptomatic from any gastrointestinal symptoms.
Collapse
|
15
|
Histopathology findings of resected gastric specimens post sleeve gastrectomy: A cross-sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Response to Letter to the Editor: The Association of Helicobacter pylori, Eradication, and Early Complications of Laparoscopic Sleeve Gastrectomy. Obes Surg 2022; 32:2081-2082. [DOI: 10.1007/s11695-022-06046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
|
17
|
The Association of Helicobacter pylori, Eradication, and Early Complications of Laparoscopic Sleeve Gastrectomy. Obes Surg 2022; 32:1617-1623. [PMID: 35278191 DOI: 10.1007/s11695-022-05996-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (SG) is a common and effective bariatric surgery, with low postoperative complication rates. It is important to define modifiable risk factors for complications. The possible association of Helicobacter pylori (HP) on SG outcomes is still being investigated. We aimed to examine HP prevalence in SG specimens, the association to early (30-day) complications, and impact of preoperative HP eradication on outcomes. MATERIALS AND METHODS This is a retrospective analysis of all consecutive patients who underwent SG between January 2012 and December 2020 in a single bariatric center. Data were retrieved from our prospectively maintained patient registry database. The 30-day outcomes were compared according to the HP status of the resected specimen: positive and negative, with or without preoperative HP eradication therapy. RESULTS There were 1985 patients; of them, 179 patients were HP positive and 1806 were HP negative in resected specimens. The overall early complication and major (Clavien-Dindo ≥ 3) complication rates were 8.6% and 3.2% (p = 0.48 and p = 0.21), respectively. A total of 111 patients were HP positive on preoperative endoscopic biopsy and received eradication therapy. All were HP negative on preoperative urea breath test, and 65.45% had HP negative resected specimens. HP eradication did not affect overall and major complications (p = 0.68 and p = 0.48, respectively). CONCLUSION The presence of HP does not seem to affect the early outcomes of SG. HP eradication does not change the early postoperative course either. Therefore, the role of routine preoperative HP screening may be limited, and eradication can be completed following SG.
Collapse
|
18
|
Tomasicchio G, Picciariello A, Dibra R, Lantone G, Trigiante G, De Fazio M, Martines G. Histopathologic findings on removed stomach after sleeve gastrectomy. Do they influence the outcome? Open Med (Wars) 2022; 17:485-491. [PMID: 35350837 PMCID: PMC8919837 DOI: 10.1515/med-2022-0450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 12/17/2022] Open
Abstract
Little is known about the role of chronic gastritis on weight loss after laparoscopic sleeve gastrectomy (LSG). This study aims to investigate the relationship between histopathologic findings of gastric specimens, excess weight loss (% EWL), and excess BMI loss (% EBL) at 6 and 12 months follow up after LSG. We retrospectively reviewed the clinical records of 95 patients who had undergone LSG between January 2017 and December 2019. Based on the histopathological findings of gastric resection specimens, patients were divided into those with chronic gastritis (CG) and those without chronic gastritis (NoCG) and compared for their % EWL and % EBL at 6 and 12 months. The mean BMI was 44.74 kg/m2 in the CG group and 44.14 kg/m2 in the NoCG group. At 6 months follow up, the CG group had a mean % EWL of 45.7 and % EBL of 40.5, while NoCG had a mean % EWL of 51.1 and % EBL of 46.7. After 1-year follow-up, the CG group had a mean % EWL of 53.1 and a % EBL of 44.8, while the NoCG group had a % EWL of 54.1 and % EBL of 44. This observational study does not support the hypothesis that the occurrence of chronic gastritis can affect postoperative % EWL and % EBL.
Collapse
Affiliation(s)
- Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Rigers Dibra
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuliano Lantone
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Michele De Fazio
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| | - Gennaro Martines
- Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza Giulio Cesare, 11, Bari, Puglia, Italy
| |
Collapse
|
19
|
Taha-Mehlitz S, Mongelli F, Sykora M, Scheiwiller A, Diebold J, Metzger J, Gass JM. Routine histopathologic examination of the resected specimen after laparoscopic sleeve gastrectomy - what can be expected? Acta Chir Belg 2021; 121:380-385. [PMID: 32644013 DOI: 10.1080/00015458.2020.1794335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Laparoscopic Sleeve Gastrectomy (LSG) is nowadays an established bariatric procedure. Although preoperative gastroscopy is recommended to rule out severe pathologies, there is little evidence about the role of routine histopathologic examination of resected specimens. We sought to identify the prevalence of histopathological relevant findings in patients undergoing LSG and to evaluate their impact in clinical practice. METHODS A retrospective analysis on a prospectively collected dataset on patients undergoing LSG between August 2009 and May 2018 in two bariatric centers was performed. Demographic and clinical data and histopathological results were analyzed. RESULTS Sixhundred-thrirteen patients were identified, mean age was 43.1 years (14-75), average body mass index was 44.8 kg/m2 (34.4-73.9). Histopathology revealed abnormal findings in 47.97% of the patients, most common pathology was chronic non-active or minimally to moderate active gastritis (n = 202;32.95%). Among others, Helicobacter-associated gastritis (n = 33;5.38%), intestinal metaplasia (n = 13;2.12%), micronodular enterochromaffine-like cell hyperplasia (n = 2; 0.33%) and gastrointestinal stromal tumors (n = 6; 0.98%) were present. No malignancies were found. Histopathological results required a change in the postoperative management in 48 patients (7.83%). The costs of histopathological assessment ranged between 0.77% and 2.55% of per-case payment. CONCLUSION A wide range of histopathological findings occur in specimens after LSG, requiring a relevant number of patients additional therapies or surveillance. Therefore, routine histopathological examination after LSG is recommendable.
Collapse
Affiliation(s)
| | - Francesco Mongelli
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Martin Sykora
- Department of General Surgery, Cantonal Hospital of Nidwalden, Postfach, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Joachim Diebold
- Department of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| |
Collapse
|
20
|
Komaei I, Currò G, Mento F, Cassaro G, Lazzara C, Barbera A, Ammendola M, Alibrandi A, Navarra G. Gastric Histopathologic Findings in South Italian Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Is Histopathologic Examination of All Resected Gastric Specimens Necessary? Obes Surg 2021; 30:1339-1346. [PMID: 31713151 DOI: 10.1007/s11695-019-04272-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up. MATERIALS AND METHODS Clinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings. RESULTS Chronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000). CONCLUSION Histopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.
Collapse
Affiliation(s)
- Iman Komaei
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Giuseppe Currò
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy. .,Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Federica Mento
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Gabriele Cassaro
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Claudio Lazzara
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Adalberto Barbera
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Michele Ammendola
- Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| |
Collapse
|
21
|
Nowak K, Di Palma A, Chieu K, Quereshy F, Jackson T, Okrainec A, Serra S, Chetty R. Histologic and Cost-Benefit Analysis of Laparoscopic Sleeve Gastrectomy Specimens Performed for Morbid Obesity. Arch Pathol Lab Med 2021; 145:365-370. [PMID: 32649836 DOI: 10.5858/arpa.2020-0084-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Laparoscopic sleeve gastrectomy (LSG) has quickly become the bariatric surgical procedure of choice for patients with obesity who have failed medical management. Laparoscopic sleeve gastrectomy results in a gastric remnant that is routinely subject to pathologic examination. OBJECTIVE.— To perform a histologic and cost-benefit analysis of gastric remnants post-LSG. DESIGN.— All LSG cases performed at University Health Network, Toronto, Ontario, Canada, between 2010 and 2019 were reviewed. Specimens that underwent routine histopathologic assessment and ancillary immunohistochemical analysis were analyzed. Baseline patient characteristics and surgical outcomes were obtained from our internal database. The total cost of specimen gross preparation, examination, sampling, and producing and reporting a hematoxylin-eosin slide was calculated. RESULTS.— A total of 572 patients underwent LSG during the study period and had their specimens examined histologically. A mean of 4.87 blocks generating 4 hematoxylin-eosin slides was produced. The most common histologic findings reported in LSG specimens ranged from no pathologic abnormalities identified together with proton pump inhibitor-related change. A minority of cases demonstrated clinically actionable histologic findings, of which Helicobacter pylori infection was the most common. The total cost for the complete pathologic analysis of these cases amounted to CaD $66 383.10 (US $47 080.21) with a mean of CaD $116.05 (US $82.40) per case. A total of CaD $62 622.75 (US $44 413.30) was spent on full examination of cases that had no further postoperative clinical impact. CONCLUSIONS.— There is a broad spectrum of pathologic findings in LSG specimens, ranging from clinically nonactionable to more clinically actionable. The vast majority of histologic findings had no clinical impact, with only a minority of cases being clinically significant. This study therefore recommends that LSG specimens be subject to gross pathologic examination in the vast majority of cases. However, sections should be submitted for microscopic analysis if grossly evident lesions are present and if there is a clinical/known history of clinically actionable findings.
Collapse
Affiliation(s)
- Klaudia Nowak
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty)
| | - Adam Di Palma
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Kenny Chieu
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty)
| | - Fayez Quereshy
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Timothy Jackson
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Allan Okrainec
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Stefano Serra
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty)
| | - Runjan Chetty
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty).,University Health Network and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
22
|
An Unexpected Finding of Gastrointestinal Stromal Tumors During Laparoscopic Sleeve Gastrectomy; How to Deal? How Much Safety Margin Needed? INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.104481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is an increasing incidence of coincidental gastric gastrointestinal stromal tumors (GIST) during a laparoscopic sleeve gastrectomy (LSG). Resection with negative margin R0 is the safest and most proper treatment. Objectives: The incidence of GIST in patients undergoing LSG and resection with a 1- to 2-cm safety margin was validated and analyzed. The primary endpoint is that can simultaneous excision be oncologically adequate or not? How much GIST is supposed to be far from a staple line? Methods: The present prospective study included 338 patients with body mass index (BMI) ≥ 35. All patients underwent LSG without known history or imaging reveal GIST. Resection was done with a safety margin of 1 to 2 cm away from the stapled margin and, then, sent for histopathology and immunohistochemically staining. Results: A total of 17 patients (5%) had coincidental GIST. The size was T1 in 88.2% of patients; 16 patients were staged as IA according to the American Joint Committee on Cancer (AJCC TNM). Safety margin was ≤ 1 cm for 3 patients to avoid incorporation in staple line and 14 patients (82.3%) had 2 cm safety margin. Resection margin in biopsy revealed positive resection margin R1 for 2 patients, whose safety margin was only 1 cm or less. A total of 15 patients had a negative margin (R0), whose safety margin was 2 cm. Conclusions: Any incidental GIST can be removed safely during LSG as long as it is far from the staple line with at least a 2-cm safety margin and negative resection margins without changing the procedure. Margins less than 1 cm are associated with adverse prognostic factors.
Collapse
|
23
|
Helicobacter pylori Prevalence in Laparoscopic Sleeve Gastrectomy Specimen. Gastroenterol Res Pract 2020; 2020:8843696. [PMID: 33381168 PMCID: PMC7748889 DOI: 10.1155/2020/8843696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Laparoscopic sleeve gastrectomy (LSG) has become a common surgical procedure. The value of routine histopathologic examination of the LSG specimens remains, however, a controversial issue. Helicobacter pylori was the most prevalent finding in several previous studies, but the overall results were dissimilar. We aim to assess the prevalence of Helicobacter pylori and other histopathologic findings in LSG specimens and the effect of increasing the number of sections for histology, from LSG specimens, on the rates of abnormal findings. Methods We retrospectively reviewed the histopathologic data of all patients who had undergone LSG, in a tertiary care center, over a 4-year period (n = 481). Patient characteristics and histopathologic findings were recorded and analyzed. Results Inactive chronic gastritis was the most common histopathologic finding (62.16%) followed by Helicobacter pylori gastritis (35.34%). Intestinal metaplasia was identified in 1.66% of the cases. There was no diagnosis of malignancy. Increasing the number of sections submitted for histopathologic examination resulted in a significantly higher rate of H. pylori gastritis detection. Conclusion Routine histopathologic examination of LSG specimens may detect H. pylori in a significant proportion of patients, and increasing the number of sections for histology from LSG specimens improves the rate of detection of this bacterium and identifies individuals who may benefit from treatment.
Collapse
|
24
|
Gastrointestinal Stromal Tumors in Saudi Arabia: a Comprehensive Review in the Light of Recent Literature. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
25
|
AlAli MN, Bamehriz F, Arishi H, Aldeghaither MK, Alabdullatif F, Alnaeem KA, Alzamil AF, AlHashim IR, Alhaizan S, Aljuhani T, Aldohayan A. Trends in bariatric surgery and incidentalomas at a single institution in Saudi Arabia: a retrospective study and literature review. Ann Saudi Med 2020; 40:389-395. [PMID: 33007169 PMCID: PMC7532056 DOI: 10.5144/0256-4947.2020.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data are lacking on trends in bariatric surgery and the frequency of incidental findings in Saudi Arabia. OBJECTIVE Report on trends in bariatric surgery as well as our experience in incidental findings along with a literature review (mainly on gastrointestinal stromal tumor). DESIGN Retrospective chart and literature review. SETTINGS Academic tertiary care center. PATIENTS AND METHODS We conducted a retrospective study at King Khalid University Hospital and analyzed the data collected from 2009 to 2019. We collected data on age, body mass index (BMI), H pylori infection, type of bariatric surgery performed, and type and location of incidental findings. MAIN OUTCOME MEASURES Incidental findings during or after bariatric surgery (in pathology specimen). SAMPLE SIZE 3052 bariatric surgeries, 46 patients with incidentalomas. RESULTS The mean and standard deviation for the age of the 46 patients with incidentalomas was 42.1 (13.9) years and the mean (SD) preoperative BMI was 43.4 (6.4) kg/m2. Of 3052 bariatric surgeries performed, the most common type was sleeve gastrectomy (93.9%), followed by gastric bypass surgery (4.58%) and gastric banding (1.47%). The total frequency of incidentalomas was 1.5%; 10.8% of patients had gastrointestinal stromal tumors (GIST), with the stomach being the commonest site for incidental findings. Eighty percent of the patients with GIST were positive for H pylori (P=.01 vs negative patients). CONCLUSION The number of incidentalomas and other findings were consistent with other reports. All these findings suggest that bariatric surgeons should take special care before, during, and after a laparoscopic operation in obese patients. LIMITATIONS Since this is a single-center, retrospective study, we did not collect data on important variables such as gender, socioeconomic status of the patient, and family history of obesity, and we did not perform a preoperative esophagogastroduodenoscopy. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
- Mohammed Nabil AlAli
- From the Department of General Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Fahad Bamehriz
- From the Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Arishi
- From the Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Alabdullatif
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alnaeem
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Ibrahim R AlHashim
- From the College of Medicine, King Faisal University, Al-Hasa, Eastern Province, Saudi Arabia
| | - Sarah Alhaizan
- From the Department of General Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Tarek Aljuhani
- From the Department of Pathology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Abdullah Aldohayan
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
26
|
HISTOPATHOLOGICAL FINDINGS AND CLINICAL OUTCOMES OF PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.732733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
27
|
Hashimoto K, Sakaguchi Y, Nambara S, Kudou K, Kusumoto E, Yoshinaga K, Kusumoto T, Ikejiri K. Laparoscopic sleeve gastrectomy performed in a morbidly obese patient with gastrointestinal stromal tumor: a case report and literature review. Surg Case Rep 2020; 6:208. [PMID: 32785860 PMCID: PMC7423818 DOI: 10.1186/s40792-020-00976-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is the most frequent submucosal tumor, and with advancements of diagnostic modalities, the incidence of GIST cases diagnosed have increased. Similarly, prevalence of morbid obesity has also rapidly increased over the past decade. Notably, the incidence of GIST in obese patients was reported to be more frequent as compared to the general population. Despite local resection being the first choice for GIST treatment, extensive surgery should also be considered depending on the tumor size and location. Laparoscopic sleeve gastrectomy (LSG), the most popular bariatric procedure, could also be a concomitant treatment option for both morbid obesity and GIST when the tumor is contained within LSG the excision range. There are, however, few reports about LSG planned for GIST preoperatively. Case presentation A morbidly obese 46-year-old Japanese male (body weight of 105.4 kg, body mass index (BMI) of 36.6 kg/m2) was diagnosed with an intramural GIST in the gastric fundus. Because of his extreme visceral fat dominated obesity (visceral fat area of 386 cm2), in addition to the size and location of the tumor, we determined that it would be difficult to perform local resection. We planned LSG as a concomitant treatment for both GIST and morbid obesity. After the preoperative examination and 6 months of weight control, the patient lost enough weight to undergo LSG safely. Keeping enough distance away from the tumor, which we observed with an endoscope, we performed LSG to successfully resect the tumor. The patient was discharged uneventfully. Weight loss was successful as his BMI was 21.0 kg/m2 at 3 months post-surgery. Conclusion We successfully performed LSG in a morbidly obese patient with a large GIST. This is the largest GIST concomitantly resected with LSG reported within current literature.
Collapse
Affiliation(s)
- Kenkichi Hashimoto
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan.
| | - Yoshihisa Sakaguchi
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| | - Sho Nambara
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| | - Kensuke Kudou
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| | - Eiji Kusumoto
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| | - Keiji Yoshinaga
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| | - Tetsuya Kusumoto
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| | - Koji Ikejiri
- Department of Gastroenterological Surgery/Clinical Research Institute, National Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, Japan
| |
Collapse
|
28
|
Fernández JA, Frutos MD, Ruiz-Manzanera JJ. Incidental Gastrointestinal Stromal Tumors (GISTs) and Bariatric Surgery: A Review. Obes Surg 2020; 30:4529-4541. [DOI: 10.1007/s11695-020-04853-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
|
29
|
Kermansaravi M, Kabir A, Pazouki A. 1-Year Follow-up of Single Anastomosis Sleeve Ileal (SASI) Bypass in Morbid Obese Patients: Efficacy and Concerns. Obes Surg 2020; 30:4286-4292. [DOI: 10.1007/s11695-020-04781-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022]
|
30
|
Nowak K, DiPalma A, Serra S, Quereshy F, Jackson T, Okrainec A, Chetty R. Review of pathological findings in laparoscopic sleeve gastrectomy specimens performed for morbid obesity. J Clin Pathol 2020; 73:618-623. [PMID: 32591353 DOI: 10.1136/jclinpath-2020-206428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgical procedures are employed when there is a failure of lifestyle modification in arresting obesity. Laparoscopic sleeve gastrectomy (LSG) is quickly becoming the bariatric surgical procedure of choice. LSG results in a gastric remnant that is subject to pathological examination. The objective of this paper is to review the literature in regard to histological findings identified in gastric remnants post-LSG and identify the most pertinent histological findings. MATERIALS AND METHODS A literature search was performed to identify relevant case series. Data gathered from relevant case series then underwent statistical analysis. RESULTS The most common histological findings in an LSG specimen were clinically indolent findings such as no pathological abnormalities identified followed by non-specific gastritis. A minority of cases demonstrated clinically actionable findings for which Helicobacter pylori represented the majority of these findings. CONCLUSION There is a broad spectrum of pathological findings in LSG specimens, ranging from clinically indolent to clinically actionable. The most common histological findings are clinically indolent and only a small portion are of clinical significance and, hence, actionable.
Collapse
Affiliation(s)
- Klaudia Nowak
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Adam DiPalma
- Department of General Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Stefano Serra
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Fayez Quereshy
- Department of General Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Timothy Jackson
- Department of General Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Allan Okrainec
- Department of General Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Runjan Chetty
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Turan G, Kocaöz S. Helicobacter Pylori Infection Prevalence and Histopathologic Findings in Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 29:3674-3679. [PMID: 31290105 DOI: 10.1007/s11695-019-04052-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) is a type of bacteria that affects more than half of the world's population and has been associated with gastritis. The relationship between H. pylori and obesity is controversial. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used surgery for morbidly obese patients. The aim of this study was to investigate the rate of H. pylori in patients undergoing LSG. METHODS Biopsy specimens of 32,743 patients who underwent esophagogastroduodenoscopy (EGD) and resection materials from 1257 patients who underwent LSG were examined histopathologically. The relationships between body mass index (BMI), age, gender, H. pylori infection, and intestinal metaplasia (IM) were investigated in patients with gastritis. RESULTS In patients undergoing EGD, the association of H. pylori infection was found to be increased in males and the elderly (p < 0.001). The presence of gastritis and IM was significantly higher with H. pylori infection (p < 0.001 and p = 0.001, respectively). H. pylori infection was significantly higher in patients over the age of 41 years (p < 0.001). There was no significant difference between the results of H. pylori before and after LSG surgery (p = 0.923). The presence of H. pylori together with gastritis and IM was found to be significant (p < 0.001). CONCLUSIONS H. pylori infection increases with age. No significant difference was found in the examination for H. pylori before and after LSG surgery. In addition, no relationship was found between H. pylori and excess weight. However, due to the low average age of patients who underwent LSG, further studies are needed in this area.
Collapse
Affiliation(s)
- Gülay Turan
- The Department of Medical Pathology, Faculty of Medicine, Balıkesir University, Çağış Yerleşkesi.10145 Bigadiç yolu üzeri 17 km, Balıkesir, Turkey
| | - Servet Kocaöz
- Department of General Surgery, Ankara Atatürk Eğitim ve Araştırma Hastanesi Üniversiteler mah, Bilkent cad., No:1, 06800 Çankaya, Ankara, Turkey.
| |
Collapse
|
32
|
Öner Rİ, Özdaş S. Histopathological Findings in Morbid Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Does H. pylori Infection Effective on Pathological Changes? Obes Surg 2019; 28:3136-3141. [PMID: 29663251 DOI: 10.1007/s11695-018-3250-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AıM: To determine the prevalence of histopathological findings requiring clinical follow-up in morbidly obese patients undergoing laparoscopic sleeve gastrectomy (LSG) and evaluate the relationship between these findings and Helicobacter pylori as well as to add more data to the published literature in this regard. MATERıAL AND METHODS: Overall, 161 morbidly obese patients with body mass index (BMI) > 40 kg/m2 who underwent LSG between May 1, 2014 and May 31, 2017 were retrospectively included in the study. The findings of the histopathological evaluation of the resected gastric material and the relationship between these findings and histopathologically detected H. pylori infection were investigated. RESULTS The study included 114 women (70.8%) and 47 men (29.2%). The mean age of the patients was 36.82 ± 10.41 years, and the mean BMI was 46.05 ± 3.76 kg/m2. H. pylori infection was detected in 103 (64%), chronic gastritis in 156, chronic active gastritis in 47, intestinal metaplasia in eight, and atrophy in seven patients. The rate of H. pylori-associated chronic gastritis was 64%, that of chronic active gastritis was 24.2%, that of lymphoid aggregation was 62.2%, and that of intestinal metaplasia and atrophy was 3.1%. There was a significant relationship between H. pylori infection and chronic gastritis, chronic active gastritis, and lymphoid aggregation; however, no significant relationship was found between intestinal metaplasia and atrophy. CONCLUSıON: Clinicians should be aware of the histopathological findings requiring clinical follow-up for LSG-treated patients. Given the complications of H. pylori infection such as lymphoma and malignancy, periodic follow-up of patients and eradication therapy may be a suitable approach for treating intestinal metaplasia and atrophic changes.
Collapse
Affiliation(s)
- Ramazan İlyas Öner
- Department of Internal Medicine, Faculty of Medicine, Adiyaman University, Yunus Emre Mah, Şifa Cad, 024000, Adiyaman, Turkey.
| | - Sabri Özdaş
- Department of General Surgery, Faculty of Medicine, Adiyaman University, Adıyaman, Turkey
| |
Collapse
|
33
|
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has gained popularity in the last 10 years for its good results in weight loss and comorbidity control. However, guidelines on the pathological examination of the specimen are lacking. The aim of this retrospective study was to determine the usefulness of the routine specimen examination when presurgery endoscopy (upper gastrointestinal endoscopy, UGIE) and multiple gastric biopsies are part of the preoperative work-up. METHODS A retrospective review of records of the patients submitted to LSG between January 2012 and August 2017 was carried out. Sex, age, histopathology findings in the presurgery endoscopy biopsies and surgical specimen, and the prevalence of Helicobacter pylori infection were analyzed. RESULTS A total of 925 patients entered the study group (mean age = 44.1 years, Females = 80.3%, BMI = 44.58 kg/m2). The most common histopathology pattern in the endoscopy biopsies and in the surgical specimens was inactive chronic gastritis (64.4 and 55.6%, respectively). Helicobacter pylori infection was 24.6 and 2.48%, respectively. Ninety-nine percent (n 796) of patients with non-significant endoscopy biopsy findings showed the same patterns in specimen analysis. Only three patients (0.3%) who had intestinal presurgery metaplasia were positive in the specimen analysis, and two cases of gastric stromal neoplasms (gastrointestinal stromal tumor and gastric leiomyoma) were found intraoperatively. CONCLUSION Most of the findings are non-significant and can be predicted if UGIE plus multiple biopsies is routinely included in the bariatric work-up with significant cost reduction. In those patients who had a significant finding prior to the surgery or intraoperatively, the pathological examination of the specimen is recommended.
Collapse
|
34
|
Unexpected histopathological findings after sleeve gastrectomy. Surg Endosc 2019; 34:2158-2163. [DOI: 10.1007/s00464-019-07002-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 12/24/2022]
|
35
|
The Relationship Between Histopathologic Findings and Body Mass Index in Sleeve Gastrectomy Materials. Obes Surg 2019. [DOI: 10.1007/s11695-018-3518-z
expr 973038445 + 868490687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
36
|
Our Experience Regarding the Association Between Gastrointestinal Stromal Tumor and Bariatric Surgery: a Response to a Letter “Gastrointestinal Stromal Tumor After Laparoscopic Sleeve Gastrectomy: Be Awake Before, During, and After a Bariatric Procedure”. Obes Surg 2018; 29:642-644. [DOI: 10.1007/s11695-018-03645-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
37
|
Influence of Helicobacter pylori infection on gastrointestinal symptoms and complications in bariatric surgery patients: a review and meta-analysis. Surg Obes Relat Dis 2018; 14:1645-1657. [DOI: 10.1016/j.soard.2018.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022]
|
38
|
Adalı Y, Binnetoğlu K, Eroğlu HA, Kaya N, Güvendi GF. The Relationship Between Histopathologic Findings and Body Mass Index in Sleeve Gastrectomy Materials. Obes Surg 2018; 29:277-280. [DOI: 10.1007/s11695-018-3518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
39
|
Musella M, Di Capua F, D’Armiento M, Velotti N, Bocchetti A, Di Lauro K, Galloro G, Campione S, Petrella G, D’Armiento FP. No Difference in Ghrelin-Producing Cell Expression in Obese Versus Non-obese Stomach: a Prospective Histopathological Case-Control Study. Obes Surg 2018; 28:3604-3610. [DOI: 10.1007/s11695-018-3401-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
40
|
Is Routine Preoperative Esophagogastroduodenoscopy Screening Necessary Prior to Laparoscopic Sleeve Gastrectomy? Review of 1555 Cases and Comparison with Current Literature. Obes Surg 2018; 28:52-60. [PMID: 28685362 DOI: 10.1007/s11695-017-2813-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Controversy exists as to whether routine preoperative esophagogastroduodenoscopy (p-OGD) in bariatric surgery should be routinely undertaken or undertaken selectively based on patients' symptoms. As very few studies have focused on the role of p-OGD prior to the increasingly common laparoscopic sleeve gastrectomy (LSG), we assessed the role/impact of p-OGD in LSG patients. METHODS Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (2011-2014, n = 1555). All patients were screened by p-OGD. Patient characteristics were analyzed, and p-OGD findings were categorized into four groups employing Sharaf et al.'s classification (Obes Surg 14:1367-1372, 23). We assessed the impact of p-OGD findings on any change in surgical management or lack thereof. RESULTS p-OGD findings indicated that 89.5% of our patients had normal or mild findings and were asymptomatic (groups 0 and 1, not necessitating any change in surgical management), and no patients had gastric cancer or varices (group 3). A total of 10.5% of our sample were categorized as group 2 patients who, according to Sharaf et al. (Obes Surg 14:1367-1372, 23), might have their surgical approach changed. All patients diagnosed preoperatively with hiatal hernia (HH) had LSG with crural repair and their symptoms resolved postoperatively. CONCLUSION Due to effectiveness and best utilization of resources, routine p-OGD screening in patients scheduled for LSG may require further justification for asymptomatic patients especially in regions with low upper GI cancers. p-OGD findings had low impact on the management of asymptomatic patients. Crural repair plus LSG was effective for hiatal hernia.
Collapse
|
41
|
An alternative view on the necessity of EGD before sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1959-1964. [DOI: 10.1016/j.soard.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 05/24/2017] [Accepted: 06/08/2017] [Indexed: 12/12/2022]
|
42
|
Rare Entities of Histopathological Findings in 755 Sleeve Gastrectomy Cases: a Synopsis of Preoperative Endoscopy Findings and Histological Evaluation of the Specimen. Obes Surg 2017; 28:1289-1295. [DOI: 10.1007/s11695-017-3014-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
43
|
Cazzo E, de Almeida de Saito HP, Pareja JC, Chaim EA, Callejas-Neto F, de Souza Coelho-Neto J. Gastric mesenchymal tumors as incidental findings during Roux-en-Y gastric bypass. Surg Obes Relat Dis 2017; 14:23-28. [PMID: 28864106 DOI: 10.1016/j.soard.2017.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Occurrences of mesenchymal tumors have been more recognized in recent years, and the incidental diagnosis of these lesions during bariatric surgery has been previously reported. OBJECTIVE To describe the cases of incidentally diagnosed mesenchymal tumors during consecutive bariatric surgeries. SETTING Private health-providing service, Brazil. METHODS A retrospective population-based study, which enrolled individuals who consecutively underwent Roux-en-Y gastric bypass at a single center from January 2006 through July 2016. RESULTS Of 1502 individuals, there were 16 cases (1.1%) of confirmed mesenchymal tumors. Of these 16 cases, 14 (87.5%) were gastrointestinal stromal tumors and 2 (12.5%) were leiomyomas. The affected individuals were significantly older (aged 46.2 ± 6.3 versus 35.4 ± 7.2 yr; P = .00031), presented a lower body mass index (38.2 ± 5.1 versus 45.3 ± 8.1 kg/m2; P<.00001), and had a lower weight (102.1 ± 17.9 versus 121.1 ± 7.4 kg; P = .00321). None of the individuals presented reported relapses of the mesenchymal tumors. CONCLUSION The possibility of incidental gastric mesenchymal tumors during bariatric surgery should not be neglected; a careful inventory of the stomach at the beginning of the procedure and resection of lesions found are mandatory. (Surg Obes Relat Dis 2017;X:XXX-XXX.) © 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Collapse
Affiliation(s)
- Everton Cazzo
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Instituto de Gastroenterologia e Cirurgia de Campinas (IGCC), Campinas, Brazil.
| | - Helena Paes de Almeida de Saito
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, Brazil; Oncology Unit, Centro de Oncologia de Campinas (COC), Campinas, Brazil
| | - José Carlos Pareja
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Centro de Cirurgia de Obesidade de Campinas (CCOC), Campinas, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Francisco Callejas-Neto
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Instituto de Gastroenterologia e Cirurgia de Campinas (IGCC), Campinas, Brazil
| | - João de Souza Coelho-Neto
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Instituto de Gastroenterologia e Cirurgia de Campinas (IGCC), Campinas, Brazil
| |
Collapse
|