The Importance of Routine Histopathological Examination in Laparoscopic Sleeve Gastrectomy Materials and the Role of Preoperative Upper Gastrointestinal Endoscopic Biopsy

Year 2021, , 325 - 332, 30.12.2021

Döndü Nergiz

https://doi.org/10.25048/tudod.1009269

Abstract

Aim: Obesity is a life threatening epidemic worldwide. Laparoscopic sleeve gastrectomy is the most common primary bariatric procedure
for the treatment of obesity. The aim of this study was to investigate the histopathological findings in laparoscopic sleeve gastrectomy
materials, and to evaluate the relationship between histopathological findings and clinicopathological factors. In addition, to examine
the histopathological findings in preoperative upper gastrointestinal endoscopic biopsies and frequency of upper gastrointestinal
malignancy during the postoperative follow-up period. Material and Methods: A total of 650 patients who underwent laparoscopic sleeve gastrectomy between August 2017- August 2021
were analyzed retrospectively. Age, gender, body mass index, histopathology findings, and the number of sampled blocks were analyzed.
Histopathological findings in preoperative upper gastrointestinal endoscopic biopsies were recorded. Follow-up data of the patients were
evaluated to determine the incidence of upper gastrointestinal malignancy after sleeve gastrectomy. The Kolmogorov-Smirnov test was
used to evaluate the assumption of normality in the data. Normal distribution continuous variables were compared using independent
sample T-test, and Mann-Whitney U test for continuous variables with non-normal distribution. Chi-square test was used to compare
proportions between groups. The P<0.05 was considered as statistically significant.
Results: Four hundred seventy-one patients (72.5%) presented abnormal histopathological findings. The most common finding was
chronic inactive gastritis. The rate of atrophic gastritis was 0.3%, the rate of Helicobacter pylori infection was 10.6%, and the rate of
intestinal metaplasia was 1.8%. Preoperative upper gastrointestinal endoscopic biopsies were performed in 457 of 650 patients and the
most common finding in biopsies was chronic inactive gastritis. No malignancies were identified in the postoperative follow-up.
Conclusion: Routine evaluation of preoperative upper gastrointestinal endoscopic biopsies provide significant findings and can guide
clinical management, however, careful macroscopic evaluation and histopathological examination should be performed on all sleeve
gastrectomy materials to detect pathologies that may be overlooked.

Keywords

Sleeve Gastrectomy, pathology, obesity, Helicobacter Pylori, biopsy

Laparoskopik Sleeve Gastrektomi Materyallerinde Rutin Histopatolojik İncelemenin Önemi ve Preoperatif Üst Gastrointestinal Endoskopik Biyopsinin Rolü

Abstract

Amaç: Obezite dünya çapında yaşamı tehdit eden bir salgındır. Laparoskopik sleeve gastrektomi obezite tedavisinde en sık uygulanan
primer bariatrik prosedürdür. Bu çalışmanın amacı, laparoskopik sleeve gastrektomi materyallerinde histopatolojik bulguları araştırmak
ve histopatolojik bulgular ile klinikopatolojik faktörler arasındaki ilişkiyi değerlendirmektir. Ayrıca ameliyat öncesi üst gastrointestinal
endoskopik biyopsilerdeki histopatolojik bulguları ve ameliyat sonrası takip döneminde üst gastrointestinal malignite sıklığını
incelemektir.
Gereç ve Yöntemler: Ağustos 2017- Ağustos 2021 tarihleri arasında laparoskopik sleeve gastrektomi yapılan toplam 650 hasta
retrospektif olarak incelendi. Yaş, cinsiyet, vücut kütle indeksi, histopatolojik bulgular ve örneklenen blok sayısı analiz edildi. Ameliyat
öncesi üst gastrointestinal endoskopik biyopsilerde saptanan histopatolojik bulgular kaydedildi. Sleeve gastrektomi operasyonundan
sonra gelişen üst gastrointestinal malignite insidansını belirlemek için hastaların takip verileri değerlendirildi. Verilerdeki normallik
varsayımını değerlendirmek için Kolmogorov-Smirnov testi kullanıldı. Normal dağılım gösteren sürekli değişkenler, bağımsız örneklem
T-testi ve normal dağılım göstermeyen sürekli değişkenler Mann-Whitney U testi kullanılarak karşılaştırıldı. Gruplar arasındaki oranları
karşılaştırmak için ki-kare testi kullanıldı. P<0,05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Dört yüz yetmiş bir hastada (%72,5) anormal histopatolojik bulgular saptandı. En sık görülen bulgu kronik inaktif gastritti.
Atrofik gastrit oranı %0,3, Helikobakter pilori enfeksiyonu oranı %10,6 ve intestinal metaplazi oranı %1,8’di. 650 hastanın 457’sine
ameliyat öncesi üst gastrointestinal endoskopik biyopsi yapılmıştı ve biyopsilerde en sık görülen bulgu kronik inaktif gastritti. Postoperatif
takipte malignite saptanmadı.
Sonuç: Ameliyat öncesi üst gastrointestinal endoskopik biyopsilerin rutin değerlendirilmesi önemli bulguların ortaya çıkarılmasını
sağlar ve klinik yönetim hakkında da yol gösterebilir ancak gözden kaçabilecek patolojileri saptamak için tüm sleeve gastrektomi
materyallerinde dikkatli makroskopik değerlendirme ve histopatolojik inceleme yapılmalıdır.

Keywords

Sleeve gastrektomi, patoloji, obezite, Helikobakter pilori, biyopsi

References

• World Health Organization. World Health organization: health topics: obesity. Geneva, Switzerland: WHO, 2018. [Çevrimiçi] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
• 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. 2020;30(4):1339-1346.
• Palermo M, Serra E. Laparoscopic Sleeve Gastrectomy: How Do I Do It. J Laparoendosc Adv Surg Tech A. 2020;30(1):2-5.
• Sabuncu T, Kıyıcı S, Eren MA, Sancak S, Sönmez A, Güldiken S, Kutlutürk F, Şahin İ, Yılmaz M, Bayram F. Summary of Bariatric Surgery Guideline of the Society of Endocrinology and Metabolism of Turkey. Turkish J Endocrinol Metab. 2017;21(4):140–7.
• Sabbah NA, Saoud CZ, Deeb M, Nasser SM. Helicobacter pylori Prevalence in Laparoscopic Sleeve Gastrectomy Specimen. Gastroenterol Res Pract. 2020;2020:8843696.
• Al Saady R, Ejeckam G. Histopathological findings in laparoscopic sleeve gastrectomy specimens. Qatar Med J. 2019;2019(1):5.
• Hansen SK, Pottorf BJ, Hollis HW Jr, Rogers JL, Husain FA. Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy?. Am J Surg. 2017;214(6):1151-1155.
• Turan G, Kocaöz S. Helicobacter Pylori Infection Prevalence and Histopathologic Findings in Laparoscopic Sleeve Gastrectomy. Obes Surg. 2019;29(11):3674-3679.
• Demirbas BT, Erdim A, Celikel C, Akbas G, Cingi A. Is it Necessary to Send the Sleeve Gastrectomy Specimens to Pathology?. Surg Laparosc Endosc Percutan Tech. 2019;29(2):117-119.
• Canil AM, Iossa A, Termine P, Caporilli D, Petrozza V, Silecchia G. Histopathology Findings in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg. 2018;28(6):1760-1765.
• Öner Rİ, Özdaş S. Histopathological Findings in Morbid Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Does H. pylori Infection Effective on Pathological Changes?. Obes Surg. 2018;28(10):3136-3141.
• 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. 2020;1-6.
• 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(3):365-370.
• Dogan U, Suren D, Oruc MT, Gokay AA, Mayir B, Cakir T, Aslaner A, Oner OZ, Bulbuller N. Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy. Eur Rev Med Pharmacol Sci. 2017;21(23):5430-5436.
• Di Palma A, Alhabdan S, Maeda A, Mattu F, Chetty R, Serra S, Quereshy F, Jackson T, Okrainec A. Unexpected histopathological findings after sleeve gastrectomy. Surg Endosc. 2020;34(5):2158-2163.
• 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(10):618-623.
• Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, Malfertheiner P, Graham DY, Wong VWS, Wu JCY, Chan FKL, Sung JJY, Kaplan GG, Ng SC. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153(2):420-429.
• Yardimci E, Bozkurt S, Baskoy L, Bektasoglu HK, Gecer MO, Yigman S, Akbulut H, Coskun H. Rare Entities of Histopathological Findings in 755 Sleeve Gastrectomy Cases: a Synopsis of Preoperative Endoscopy Findings and Histological Evaluation of the Specimen. Obes Surg. 2018;28(5):1289-1295.
• Jencks DS, Adam JD, Borum ML, Koh JM, Stephen S, Doman DB. Overview of Current Concepts in Gastric Intestinal Metaplasia and Gastric Cancer. Gastroenterol Hepatol. 2018;14(2):92-101.
• de Vries AC, van Grieken NC, Looman CW, Casparie MK, de Vries E, Meijer GA, Kuipers EJ. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology. 2008;134(4):945-952.
• Bennett S, Gostimir M, Shorr R, Mallick R, Mamazza J, Neville A. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12(5):1116-1125.
• Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass?. Obes Surg. 2013;23(6):736-739.
• Salama A, Saafan T, El Ansari W, Karam M, Bashah M. Is Routine Preoperative Esophagogastroduodenoscopy Screening Necessary Prior to Laparoscopic Sleeve Gastrectomy? Review of 1555 Cases and Comparison with Current Literature. Obes Surg. 2018;28(1):52-60.
• Fernandes SR, Meireles LC, Carrilho-Ribeiro L, Velosa J. The Role of Routine Upper Gastrointestinal Endoscopy Before Bariatric Surgery. Obes Surg. 2016;26(9):2105-2110.
• AbdullGaffar B, Raman L, Khamas A, AlBadri F. Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?. Obes Surg. 2016 Jan;26(1):105-10.
• Chen W, Wang Y, Zhu J, Wang C, Dong Z. Esophagogastric Cancer After Sleeve Gastrectomy: A Systematic Review of Case Reports. Cancer Manag Res. 2021;13:3327-3334.