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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.
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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
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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.
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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
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Makovich Z, Patel B. Late-Onset Gastric Band Erosion Following Heavy Nonsteroidal Anti-inflammatory Drug Use. ACG Case Rep J 2024; 11:e01343. [PMID: 38645472 PMCID: PMC11030015 DOI: 10.14309/crj.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Laparoscopic adjustable gastric band (LAGB) surgery is now an uncommon bariatric procedure; however, complications may still be encountered. A 64-year-old man with a history of LAGB placement 13 years prior presented with 2 months of epigastric pain. He endorsed chronic heavy nonsteroidal anti-inflammatory drug use. Computed tomography showed inflammation around the LAGB tubing with near-complete, circumferential erosion of the LAGB into the fundus. Upper endoscopy confirmed erosion of the LAGB along with port tubing into the gastroesophageal junction and fundus. The patient was referred to a foregut surgeon who performed robotic band removal.
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Affiliation(s)
- Zachary Makovich
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Brijesh Patel
- Department of Gastroenterology, James A. Haley Veterans' Hospital, Tampa, FL
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Sethi I, Aicher A, Cheema F, Powers K, Rosenbluth A, Pryor A, Spaniolas K. Postoperative outcomes for sleeve gastrectomy patients with positive pH-defined GERD. Surg Endosc 2023; 37:6861-6866. [PMID: 37311887 DOI: 10.1007/s00464-023-10149-z] [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: 02/08/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a possible side effect of sleeve gastrectomy (SG). However, procedure selection for patients with GERD and risk factors for morbidity after bypass surgeries is complex. For patients with a preoperative GERD diagnosis, literature related to worsening postoperative symptoms is discordant. OBJECTIVE This study evaluated the effects of SG on patients with pre-operative GERD confirmed through pH testing. SETTING University Hospital, United States. METHODS This was a single-center case-series. SG patients with preoperative pH testing were compared based on DeMeester scoring. Preoperative demographics, endoscopy results, need for conversion surgery, and changes in gastrointestinal quality of life (GIQLI) scores were compared. Two-sample independent t-tests assuming unequal variances were used for statistical analysis. RESULTS Twenty SG patients had preoperative pH testing. Nine patients were GERD positive; median DeMeester score 26.7 (22.1-31.15). Eleven patients were GERD negative, with a median DeMeester score of 9.0 (4.5-13.1). The two groups had similar median BMI, preoperative endoscopic findings and use of GERD medications. Concurrent hiatal hernia repair was performed in 22% of GERD positive vs. 36% of GERD negative patients, (p = 0.512). Two patients in the GERD positive cohort required conversion to gastric bypass (22%), while none in the GERD negative cohort did. No significant postoperative differences were noted in GIQLI, heartburn, or regurgitation symptoms. CONCLUSION Objective pH testing may allow the differentiation of patients who would be higher risk for need for conversion to gastric bypass. For patients with mild symptoms, but negative pH testing, SG may represent a durable option.
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Affiliation(s)
- Ila Sethi
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA.
| | - Aidan Aicher
- Division of General Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Fareed Cheema
- Department of Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Kinga Powers
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
| | - Amy Rosenbluth
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
| | - Aurora Pryor
- Department of Surgery, Long Island Jewish Medical Center, Queens, NY, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
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Wiggins T, Kazmi T, Khan Y, Singhal R. Helicobacter Stool Antigen Testing: an Alternative Method for Pre-operative Screening. Obes Surg 2023; 33:374. [PMID: 36456847 DOI: 10.1007/s11695-022-06391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Tom Wiggins
- Department of Bariatric Surgery, University Hospitals Birmingham, Bordesley Green, Birmingham, B9 5SS, UK.
| | - Tehreem Kazmi
- Department of Bariatric Surgery, University Hospitals Birmingham, Bordesley Green, Birmingham, B9 5SS, UK
| | - Yasmeen Khan
- Department of Bariatric Surgery, University Hospitals Birmingham, Bordesley Green, Birmingham, B9 5SS, UK
| | - Rishi Singhal
- Department of Bariatric Surgery, University Hospitals Birmingham, Bordesley Green, Birmingham, B9 5SS, UK
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