Adam Di Palma1, Sultan Alhabdan1, Azusa Maeda1, Fabrizio Mattu2, Runjan Chetty2,3, Stefano Serra2,3, Fayez Quereshy1,4, Timothy Jackson1,4, Allan Okrainec5,6,7. 1. Division of General Surgery, UHN, Toronto, ON, Canada. 2. Department of Pathology, UHN, Toronto, ON, Canada. 3. Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 4. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 5. Division of General Surgery, UHN, Toronto, ON, Canada. Allan.Okrainec@uhn.ca. 6. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Allan.Okrainec@uhn.ca. 7. Toronto Western Hospital, University Health Network, Toronto, ON, Canada. Allan.Okrainec@uhn.ca.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) represents one of the most commonly performed bariatric procedures and, in contrast to the Roux-en-Y gastric bypass, produces a specimen for pathologic examination. This study aims to describe unexpected histopathological findings in order to better define preoperative management of patients undergoing LSG. METHODS: All LSG cases performed at an academic center in Toronto, Ontario between 2010 and 2017 were reviewed. All specimens underwent histopathological assessment, while those with findings suspicious for neoplasia or the presence of Helicobacter pylori underwent additional immunohistochemical stainings. Baseline patient characteristics and surgical outcomes were obtained from our internal database. RESULTS: A total of 222 patients underwent LSG during the study period and had their specimens examined histologically. Among them, 22.5% underwent preoperative endoscopy. The most common histopathological diagnosis was no abnormal findings (50.9%) followed by gastritis (25.7%). Abnormal findings warranting a change in postoperative management or follow-up were discovered in 8.6% of specimens and included H. pylori infection, intestinal metaplasia, malignancy, and atrophic gastritis. Only 4.7% of all patients had not undergone preoperative endoscopy and had truly unexpected findings. No significant association was found between abnormal findings and age, sex, or baseline body mass index (BMI). CONCLUSIONS: Although a majority of patients had a gastric specimen within normal limits, 8.6% had findings requiring a change in postoperative management. This rate dropped to 4.7% when patients whose diagnoses were known preoperatively were excluded. Our findings suggest that further research is needed to better define the role of preoperative endoscopy to potentially reduce the number of unexpected findings following LSG.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) represents one of the most commonly performed bariatric procedures and, in contrast to the Roux-en-Y gastric bypass, produces a specimen for pathologic examination. This study aims to describe unexpected histopathological findings in order to better define preoperative management of patients undergoing LSG. METHODS: All LSG cases performed at an academic center in Toronto, Ontario between 2010 and 2017 were reviewed. All specimens underwent histopathological assessment, while those with findings suspicious for neoplasia or the presence of Helicobacter pylori underwent additional immunohistochemical stainings. Baseline patient characteristics and surgical outcomes were obtained from our internal database. RESULTS: A total of 222 patients underwent LSG during the study period and had their specimens examined histologically. Among them, 22.5% underwent preoperative endoscopy. The most common histopathological diagnosis was no abnormal findings (50.9%) followed by gastritis (25.7%). Abnormal findings warranting a change in postoperative management or follow-up were discovered in 8.6% of specimens and included H. pyloriinfection, intestinal metaplasia, malignancy, and atrophic gastritis. Only 4.7% of all patients had not undergone preoperative endoscopy and had truly unexpected findings. No significant association was found between abnormal findings and age, sex, or baseline body mass index (BMI). CONCLUSIONS: Although a majority of patients had a gastric specimen within normal limits, 8.6% had findings requiring a change in postoperative management. This rate dropped to 4.7% when patients whose diagnoses were known preoperatively were excluded. Our findings suggest that further research is needed to better define the role of preoperative endoscopy to potentially reduce the number of unexpected findings following LSG.
Authors: Michelle A Anderson; S Ian Gan; Robert D Fanelli; Todd H Baron; Subhas Banerjee; Brooks D Cash; Jason A Dominitz; M Edwyn Harrison; Steven O Ikenberry; Sanjay B Jagannath; David R Lichtenstein; Bo Shen; Kenneth K Lee; Trina Van Guilder; Leslie E Stewart Journal: Gastrointest Endosc Date: 2008-07 Impact factor: 9.427
Authors: Wayne J English; Eric J DeMaria; Stacy A Brethauer; Samer G Mattar; Raul J Rosenthal; John M Morton Journal: Surg Obes Relat Dis Date: 2017-12-16 Impact factor: 4.734