Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination

Tamer Safaan, Moataz Bashah, Walid El Ansari, Mohsen Karam, Tamer Safaan, Moataz Bashah, Walid El Ansari, Mohsen Karam

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history.

Methods: Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011-July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes.

Results: Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each).

Conclusion: Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.

Keywords: GIST; H. pylori; Histopathologic examination; Intestinal metaplasia; Morbid obesity; Sleeve gastrectomy; Stomach.

Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

The informed consent was waived (IRB approved, HIPAA compliant retrospective study).

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

    1. World Health Organization (2016). Obesity and overweight. [cited 2016 August 15]. Available from
    1. EMRO. Regional strategy on nutrition 2010–2019 and plan of action (2010). [cited 2016 Sept 22]. Available from
    1. Rahmouni K, Correia ML, Haynes WG, et al. Obesity-associated hypertension: new insights into mechanisms. Hypertension. 2005;45(1):9–14. doi: 10.1161/01.HYP.0000151325.83008.b4.
    1. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40-59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7):e1001673. doi: 10.1371/journal.pmed.1001673.
    1. Schirmer B, Schauer PR, et al. The surgical management of obesity. In: Brunicardi F, Andersen D, Hunter J, et al., editors. Schwartz’s principles of surgery ninth edition. USA: McGraw-Hill Companies; 2010. pp. 952–953.
    1. AbdullGaffar B, Raman L, Khamas A, et al. Should we abandon routine microscopic examination in bariatric sleeve gastrectomy specimens? Obes Surg. 2016;26(1):105–110. doi: 10.1007/s11695-015-1726-3.
    1. Clapp B. Histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS. 2015;19(1):e2013.00259. doi: 10.4293/JSLS.2013.00259.
    1. Raess PW, Baird-Howell M, Aggarwal R, et al. Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Relat Dis. 2015;11(5):1020–1023. doi: 10.1016/j.soard.2015.01.002.
    1. Almazeedi S, Al-Sabah S, Al-Mulla A, et al. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg. 2013;23:314–319. doi: 10.1007/s11695-012-0821-y.
    1. Lauti M, Gormack SE, Thomas JM, et al. What does the excised stomach from sleeve gastrectomy tell us? Obes Surg. 2016;26(4):839–842. doi: 10.1007/s11695-015-1832-2.
    1. Ohanessian SE, Rogers AM, Karamchandan DM. Spectrum of gastric histopathologies in severely obese American patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(3):595–602. doi: 10.1007/s11695-015-1801-9.
    1. Ahmed A. Histopathological spectrum of laporoscopic sleeve gastrectomies in King Fahd Hospital of the University, Al Khobar, Saudi Arabia. Khyber Med Univ J. 2012;4:39–44.
    1. Vrabie CD, Cojocaru M, Waller M, et al. The main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy. Dicle Med J. 2010;37(2):97–103.
    1. Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol. 2005;100:162. doi: 10.1111/j.1572-0241.2005.40709.x.
    1. Ohkuma K, Okada M, Murayama H, et al. Association of Helicobacter pylori infection with atrophic gastritis and intestinal metaplasia. J Gastroenterol Hepatol. 2000;15(10):1105–1112. doi: 10.1046/j.1440-1746.2000.02305.x.
    1. Leung WK, Ng EK, Chan WY, et al. Risk factors associated with the development of intestinal metaplasia in first-degree relatives of gastric cancer patients. Cancer Epidemiol Biomark Prev. 2005;14(12):2982–2986. doi: 10.1158/1055-9965.EPI-05-0181.
    1. Bornschein J, Malfertheiner P. Gastric carcinogenesis. Langenbeck’s Arch Surg. 2011;396(6):729–742. doi: 10.1007/s00423-011-0810-y.
    1. Eshraghian A. Epidemiology of Helicobacter pylori infection among the healthy population in Iran and countries of the eastern Mediterranean region: a systematic review of prevalence and risk factors. World J Gastroenterol. 2014;20(46):17618–17625. doi: 10.3748/wjg.v20.i46.17618.
    1. Khalilpour A, Kazemzadeh-Narbat M, Tamayol A, et al. Biomarkers and diagnostic tools for detection of Helicobacter pylori. Appl Microbiol Biotechnol. 2016;100(11):4723–4734. doi: 10.1007/s00253-016-7495-7.
    1. Chen XY, Liu WZ, Shi Y, et al. Helicobacter pylori associated gastric diseases and lymphoid tissue hyperplasia in gastric antral mucosa. J Clin Pathol. 2002;55(2):133–137. doi: 10.1136/jcp.55.2.133.
    1. Bayerdörffer E, Lehn N, Hatz R, et al. Topographic association between active gastritis and Campylobacter pylori colonization. J Clin Pathol. 1989;42:834–839. doi: 10.1136/jcp.42.8.834.
    1. IARC. Schistosomes, liver flukes and Helicobacter pylori. In: IARC monographs on the evaluation of carcinogenic risks to humans. Geneva: WHO Publications, 1994; 61.
    1. Kara N, Urganci N, Kalyoncu D, et al. The association between Helicobacter pylori gastritis and lymphoid aggregates, lymphoid follicles and intestinal metaplasia in gastric mucosa of children. J Paediatr Child Health. 2014;50(8):605–609. doi: 10.1111/jpc.12609.
    1. Siddiqui ST, Naz E, Danish F, et al. Frequency of Helicobacter pylori in biopsy proven gastritis and its association with lymphoid follicle formation. J Pak Med Assoc. 2011;61(2):138–141.
    1. Ahmad A, Govil Y, Frank BB. Gastric mucosa-associated lymphoid tissue lymphoma. Am J Gastroenterol. 2003;98:975–986. doi: 10.1111/j.1572-0241.2003.07424.x.
    1. Zullo A, Hassan C, Romiti A, et al. Follow-up of intestinal metaplasia in the stomach: when, how and why. World J Gastrointest Oncol. 2012;4(3):30–36. doi: 10.4251/wjgo.v4.i3.30.
    1. Yamamoto S, Watabe K, Takehara T. Is obesity a new risk factor for gastritis? Digestion. 2012;85(2):108–110. doi: 10.1159/000334680.
    1. Khedmat H, Karbasi-Afshar R, Agah S, et al. Helicobacter pylori infection in the general population: a Middle Eastern perspective. Caspian J Intern Med. 2013;4(4):745–753.
    1. Franklin AL, Koeck ES, Hamrick MC, et al. Prevalence of chronic gastritis or Helicobacter pylori infection in adolescent sleeve gastrectomy patients does not correlate with symptoms or surgical outcomes. Surg Infect. 2015;16(4):401–404. doi: 10.1089/sur.2014.153.
    1. Matsuda BJ, Li X, Hernandez BY, Ito G, Kuwada Su SK. A novel association of gastrointestinal stromal tumors (GIST) and Helicobacter pylori. Gastroenterology. 2016;148(4):S-576. doi: 10.1016/S0016-5085(15)31945-4.
    1. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumors. Br J Surg. 2003;90(10):1178–1186. doi: 10.1002/bjs.4352.
    1. Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, Fingerhut A, Garcia Caballero M, Guisado Macias JA, Mittermair R, Morino M, Msika S, Rubino F, Tacchino R, Weiner R, Neugebauer EA, European Association for Endoscopic Surgery Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES) Surg Endosc. 2005;19(2):200–221. doi: 10.1007/s00464-004-9194-1.
    1. SAGES Guidelines Committee SAGES guidelines for clinical application of laparoscopic bariatric surgery. Surg Endosc. 2008;22(10):2281–2300. doi: 10.1007/s00464-008-9913-0.
    1. Zanotti D, Elkalaawy M, Hashemi M, Jenkinson A, Adamo M. Current status of preoperative oesophago-gastro-duodenoscopy (OGD) in bariatric NHS units—a BOMSS survey. Obes Surg. 2016;26(9):2257–2262. doi: 10.1007/s11695-016-2304-z.
    1. Alvi A, Vartanian AJ. Microscopic examination of routine tonsillectomy specimens: is it necessary? Otolaryngo Head Neck Surg. 1998;119(4):361–363. doi: 10.1016/S0194-5998(98)70079-8.
    1. Lohsiriwat VL, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg. 2009;33(10):2189–2193. doi: 10.1007/s00268-009-0164-6.
    1. van Vliet JL, van Gulik TM, Verbeek PC. Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination. Dig Surg. 2013;30(4–6):472–475. doi: 10.1159/000357259.
    1. Deng YL, Xiong XZ, Zhou Y, et al. Selective histology of cholecystectomy specimens—is it justified? J Surg Res. 2015;193(1):196–201. doi: 10.1016/j.jss.2014.07.039.
    1. Ramraje SN, Pawar VI. Routine histopathologic examination of two common surgical specimens—appendix and gallbladder: is it a waste of expertise and hospital resources? Indian J Surg. 2014;76(2):127–130. doi: 10.1007/s12262-012-0645-y.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever