1
|
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
|
2
|
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
|
3
|
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
|
4
|
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
|
5
|
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
|
6
|
Kermansaravi M, Kassir R, Shahsavan M, Lainas P, Chiappetta S. Approach to Gastric Intestinal Metaplasia Before Bariatric Surgery. Obes Surg 2023; 33:366-367. [PMID: 36417118 DOI: 10.1007/s11695-022-06357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 10/25/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool‑E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. .,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
| | - Radwan Kassir
- Department of Digestive Surgery, Center Hospitalier, Universitaire Félix Guyon, St Denis de La Réunion, France
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Panagiotis Lainas
- Metropolitan Hospital of Athens, HEAL Academy, Athens, Greece. .,Department of Minimally Invasive Digestive Surgery, Antoine‑Béclère Hospital, Paris-Saclay University, Clamart, France.
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| |
Collapse
|
7
|
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
|
8
|
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
|
9
|
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
|
10
|
Doulberis M, Pierre NT, Manzini G, Papaefthymiou A, Kountouras J, Klukowska-Rötzler J, Polyzos SA, Srivastava S, Exadaktylos AK, Knuchel J, Kuntzen T, Srivastava DS. Helicobacter pylori-Related Metabolic Parameters and Premalignant Gastric Mucosa Histological Lesions in Swiss Bariatric Patients. Microorganisms 2021; 9:microorganisms9071361. [PMID: 34201748 PMCID: PMC8303942 DOI: 10.3390/microorganisms9071361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
Obesity, as a major risk factor of metabolic syndrome (MetS), represents a pandemic, especially in Western societies, and is considered a risk factor for malignancies. Helicobacter pylori (Hp), is a definite carcinogen with global distribution. We aimed to investigate, for the first time in Switzerland, the main gastric mucosa premalignant histological lesions of bariatric patients in correlation with MetS components and Hp Infection (Hp-I). By reviewing retrospectively 94304 patient cases, a total of 116 eligible patients having undergone bariatric surgery were identified. The mean patient age was 48.66 years. Hp(+) patients were 24% (28/116). Presence of gastric mucosa atrophy was documented in 8/28 Hp(+) patients (29%) and (2/88) Hp(-) ones (2%) (p = 0.006). Gastric mucosa intestinal metaplasia was observed in 14/28 (50%) Hp(+) patients versus 3/88 (3.4%) of Hp(-) group (p < 0.0001). Hp(+) patients exhibited statistically higher arterial hypertension (p = 0.033). The homeostatic model of assessment insulin resistance was also statistically significantly higher for the Hp(+) group (p < 0.001). In a multivariate analysis, including arterial hypertension, gastric mucosa atrophy, and intestinal metaplasia as variables, statistical significance remained only for intestinal metaplasia (p = 0.001). In conclusion, Hp-I is associated with premalignant gastric mucosa histologic lesions and MetS components, including arterial hypertension and IR. Further large-scale prospective studies are required to confirm these findings.
Collapse
Affiliation(s)
- Michael Doulberis
- Emergency Department, University Hospital Inselspital of Bern, 3010 Bern, Switzerland; (N.T.P.); (J.K.-R.); (A.K.E.); (D.S.S.)
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland; (J.K.); (T.K.)
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (A.P.); (J.K.)
- First Laboratory of Pharmacology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Macedonia, Greece;
- Correspondence:
| | - Noah Thierry Pierre
- Emergency Department, University Hospital Inselspital of Bern, 3010 Bern, Switzerland; (N.T.P.); (J.K.-R.); (A.K.E.); (D.S.S.)
- Private Practice, 4704 Niederbipp, Switzerland
| | - Giulia Manzini
- Department of General and Visceral Surgery, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (A.P.); (J.K.)
- First Laboratory of Pharmacology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Macedonia, Greece;
- Department of Gastroenterology, University Hospital of Larisa, Mezourlo, 41110 Larisa, Thessaly, Greece
| | - Jannis Kountouras
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (A.P.); (J.K.)
| | - Jolanta Klukowska-Rötzler
- Emergency Department, University Hospital Inselspital of Bern, 3010 Bern, Switzerland; (N.T.P.); (J.K.-R.); (A.K.E.); (D.S.S.)
| | - Stergios A. Polyzos
- First Laboratory of Pharmacology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Macedonia, Greece;
| | | | - Aristomenis K. Exadaktylos
- Emergency Department, University Hospital Inselspital of Bern, 3010 Bern, Switzerland; (N.T.P.); (J.K.-R.); (A.K.E.); (D.S.S.)
| | - Jürg Knuchel
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland; (J.K.); (T.K.)
| | - Thomas Kuntzen
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland; (J.K.); (T.K.)
| | - David S. Srivastava
- Emergency Department, University Hospital Inselspital of Bern, 3010 Bern, Switzerland; (N.T.P.); (J.K.-R.); (A.K.E.); (D.S.S.)
- Department of General Internal Medicine, Kliniken Hirslanden Beau-Site, 3013 Bern, Switzerland
| |
Collapse
|
11
|
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
|
12
|
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
|
13
|
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
|
14
|
El Ansari W, El-Menyar A, Sathian B, Al-Thani H, Al-Kuwari M, Al-Ansari A. Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-analysis of 10,685 Patients. Obes Surg 2020; 30:3073-3083. [PMID: 32468339 PMCID: PMC7305097 DOI: 10.1007/s11695-020-04672-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). METHODS Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000-30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. RESULTS Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45-67%); Group 1, 2064 patients (26%, 95% CI: 23-50%); Group 2, 1351 patients (16%, 95% CI: 11-21%); and Group 3 included 31 patients (0.4%, 95% CI: 0-1%). CONCLUSION For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to "necessary" substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required.
Collapse
Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Brijesh Sathian
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | | | | |
Collapse
|
15
|
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]
|
16
|
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
|
17
|
Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique. Obes Surg 2020; 30:4375-4380. [PMID: 32588172 DOI: 10.1007/s11695-020-04800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. MATERIALS AND METHODS A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. RESULTS A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. CONCLUSION Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.
Collapse
|
18
|
Saafan T, El Ansari W, Bashah M. Compared to What? Is BMI Associated with Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens? Obes Surg 2020; 29:2166-2173. [PMID: 30989568 DOI: 10.1007/s11695-019-03801-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a risk for many different cancers. Laparoscopic sleeve gastrectomy (LSG) is common, and benign or pre-malignant histopathology types are reported in the removed gastric specimens. We assessed whether higher BMI was associated with certain benign or pre-malignant histopathological changes. METHOD Retrospective chart review of all primary LSG patients (N = 1555). Demographic, clinical, and LSG histopathology data were retrieved. BMI of patients with specific benign or pre-malignant conditions in their gastric specimens was compared with the BMI of the rest of the patients with abnormal histopathology specimens and also compared with the BMI of patients with normal control specimens. RESULTS Females comprised 70% of the patients. Mean BMI were 46.3 (females) and 48 (males). Normal LSG specimens comprised 52%. Most common abnormal histopathologies were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), lymphoid aggregates (2.2%), intestinal metaplasia (1.4%) and GIST (0.7%). After controlling for confounders (age, gender, H. pylori, diabetes mellitus type 2, hypertension), no significant association was observed between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies. CONCLUSION When confounders were taken into account, there appeared no significant associations between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies of their gastric specimens. There was a very weak correlation between BMI and other covariates.
Collapse
Affiliation(s)
- Tamer Saafan
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. .,College of Medicine, Qatar University, Doha, Qatar. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Moataz Bashah
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
| |
Collapse
|
19
|
El Ansari W, El-Menyar A. Is routine preoperative esophagogastroduodenscopy prior to bariatric surgery mandatory? protocol for a systematic review and meta-analysis. Int J Surg Protoc 2020; 22:1-5. [PMID: 32405604 PMCID: PMC7210597 DOI: 10.1016/j.isjp.2020.04.001] [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: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Routine preoperative esophagogastroduodenscopy (p-EGD) prior to bariatric surgery (BS) is currently widely undertaken, and hence an important issue with many clinical and financial repercussions. Yet, the true extent of why p-EGD is routinely undertaken for all bariatric patients remains not well understood. METHODS AND ANALYSIS To address this, we will undertake a systematic review and meta-analysis of routine p-EGD prior to BS from around the world. This protocol describes the methodological approach to be adopted and outlines the search strategies and eligibility criteria that will be employed to identify and select studies, and the way by which data from the selected studies will be extracted for analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, Cochrane Library, MEDLINE, Scopus, clinicaltrials.gov and Google scholar will be searched from 01 January 2000 to 30 April 2019 for original studies written in English that provided prevalence estimates of the outcomes of routine p-EGD prior to BS. STROBE criteria will assess the methodological quality of the selected studies. The use of fixed or random effects model will depend on the results of statistical tests for heterogeneity. Publication bias will be visually estimated by assessing funnel plots. Pooled estimates will be calculated. This protocol conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and has been submitted for registration at the PROSPERO International Prospective Register of systematic reviews. No ethical clearance is required for this study. This review will be published in a peer- reviewed journal and will be presented at various national and international conferences.
Collapse
Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, Qatar University, Doha 2713, Qatar
- Schools of Health and Education, University of Skovde, 541 28 Skövde, Sweden
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha 24144, Qatar
| |
Collapse
|
20
|
The Relationship Between Histopathologic Findings and Weight Loss in Laparoscopic Sleeve Gastrectomy. Obes Surg 2019; 30:478-482. [DOI: 10.1007/s11695-019-04185-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
21
|
Walędziak M, Różańska-Walędziak A, Janik MR, Paśnik KW, Kowalewski PK. Macroscopic Evaluation of Gastric Specimens After Laparoscopic Sleeve Gastrectomy-an Optimum Screening Test for Incidental Pathologies? Obes Surg 2018; 29:28-31. [PMID: 30187420 PMCID: PMC6320350 DOI: 10.1007/s11695-018-3485-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers’ concern, the point of histological exam of each resected tissue may be questioned. Material/Methods We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination. Results In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4–99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6–99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95–99.9%, p < 0.0001). Conclusions During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.
Collapse
Affiliation(s)
- Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland.
| | | | - Michał R Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| | - Krzysztof W Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| | - Piotr K Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| |
Collapse
|