Can histopathology of gastric tissue resected in sleeve gastrectomy be informative about serum iron levels?

Abstract

Aim: One of the most common post-operative deficiencies after bariatric surgery is iron deficiency and one of the important determinants of post-operative iron deficiency is the preoperative condition. In this study, it was aimed to investigate the relationship between iron levels and histopathological findings observed in gastric tissue resected in sleeve gastrectomy. Materials and methods: Preoperative and postoperative iron levels were compared with the presence of inflammation, atrophy, Helicobacter pylori, intestinal metaplasia, lymphoid follicles and lymphoid aggregates observed in patients operated due to morbid obesity. Findings: The postoperative serum iron levels and preoperative values were compared and a statistically significant increase was found due to the use of iron-containing preparations after the operation. Among the parameters evaluated, inflammation, atrophy, Helicobacter pylori, intestinal metaplasia, and the presence of lymphoid follicles were not found to be associated with iron levels, but it was noted that the presence of lymphoid aggregate in all cases and male cases was correlated with preoperative low iron levels (p values 0.047 and 0.015 respectively). Conclusion: In this study, which investigated the role of histopathological findings in the prediction of iron deficiency in sleeve gastrectomies, the relationship between preoperative iron levels, which was reported to be predictive for post-operative iron deficiency, and the presence of lymphoid aggregates was revealed. It is thought that other histopathological findings such as the presence of lymphoid follicle and Helicobacter pylori are also important in terms of iron levels but could not be revealed due to the limitations of the study.

Keywords

• Iron deficiency
• sleeve gastrectomy
• Histopathology
• Lymphoid agregate

References

1. • Al-Mutawa, A.; Al-Sabah, S.; Anderson, A.K.; Al-Mutawa, M. Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy-5-Year Outcomes. Obes Surg. 2018 Jun;28(6):1473-1483. doi: 10.1007/s11695-017-3041-7.
2. • Alvarez, V.; Cuevas, A.; Olivos, C.; et al. Déficit de micronutrientes a más de un año de postoperatorio en gastrectomía en manga. Nutr Hosp. 2014;29: 73–9.
3. • Bailly, L.; Schiavo, L.; Sebastianelli, L.; et al. Anemia and Bariatric Surgery: Results of a National French Survey on Administrative Data of 306,298 Consecutive Patients Between 2008 and 2016. Obes Surg. 2018 Aug;28(8):2313-2320. doi: 10.1007/s11695-018-3143-x.
4. • Braghetto, I.; Davanzo, C.; Korn, O.; et al. Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg. 2009;19(11):1515–21.
5. • Carpentieri, D.F; Wenner, W.; Liquornik, K.; Ruchelli, E. Significance of lymphoid follicles and aggregates in gastric mucosa of children. Pediatr Dev Pathol. 2000 Mar-Apr;3(2):177-9. doi: 10.1007/s100240050022
6. • Chakhachiro, Z.; Saroufim, M.; Safadi, B.; et al. Plasma cells and lymphoid aggregates in sleeve gastrectomy specimens: Normal or gastritis? Medicine (Baltimore). 2020 Feb;99(6):e18926. doi: 10.1097/MD.0000000000018926.
7. • Chang, S.H.; Stoll, C.R.; Song, J.; et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3): 275–87. doi:10.1001/jamasurg.2013.3654.
8. • Coupaye, M,; Rivière, P.; Breuil, M.C.; et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014 Feb;24(2):276-83.

9. • Del Villar Madrigal, E.; Neme-Yunes, Y.; Clavellina-Gaytan, D.; et al., Anemia after Roux-en-Y gastric bypass. How feasible to eliminate the risk by proper supplementation? Obes Surg. 2015 Jan;25(1):80-4. doi: 10.1007/s11695-014-1356-1.
10. • Eroğlu, H.A.; Adali, Y; Beşeren, H; et al. Association of Histopathology and Hemogram Findings Following Sleeve Gastrectomy. Bariatric Surgical Practice and Patient CareVol. 14, No. 4. doi: 10.1089/bari.2019.0053
11. • Esposito, K.; Pontillo, A.; Di Palo, C; et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA. 2003;289: 1799– 804
12. • Guan, B.; Yang, J.; Chen, Y.; et al. Nutritional Deficiencies in Chinese Patients Undergoing Gastric Bypass and Sleeve Gastrectomy: Prevalence and Predictors. Obes Surg. 2018 May 12. doi: 10.1007/s11695-018-3225-9.
13. • Guh, D.P.; Zhang, W.; Bansback, N; et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9: 88. doi:10.1186/1471-2458-9-88.
14. • Hakeam, H.; O’Regan, P.; Salem, A.; et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19(11):1491–6. https://doi.org/10.1007/s11695-009-9919-2.
15. • IARC (2002). IARC Handbooks of Cancer Prevention. Weight Control and Physical Activity. International Agency for Research on Cancer: Lyon.
16. • Mechanick, J.I.; Youdim, A.; Jones, D.B.; et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American association of clinical endocrinologists, the obesity society, and American society for metabolic & bariatric surgery. Obesity. 2013;21(SUPPL. 1): S1–S27
17. • Melissas, J.; Daskalakis, M.; Koukouraki, S.; et al. Sleeve gastrectomy-a "food limiting" operation. Obes Surg. 2008;18(10):1251–6.
18. • Mitka, M. Surgery for obesity: demand soars amid scientific, ethical questions. Jama. 2003;289(14):1761–2.
19. • Moizé, V.; Deulofeu, R.; Torres, F.; et al. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21(9):1382–8. https://doi. org/10.1007/s11695-011-0360-y.
20. • Ponsky, T.A.; Brody, F.; Pucci, E. Alterations in gastrointestinal physiology after Roux-en-Y gastric bypass. J Am Coll Surg. 2005;201(1): 125–31.
21. • Saif, T.; Strain, G.; Dakin, G.; et al. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8(5):542–7. https://doi.org/10.1016/j.soard. 2012.01.013.
22. • Sjostrom, L.; Kindroos, A.K.; Peltonen, M.; et al. Lifestyle, diabetes, and cardiovascular risk fac-tors 10 years after bariatric surgery. N Engl J Med 2004 23; 351: 2683-93.
23. • Snyder-Marlow, G.; Taylor, D.; Lenhard, M.J. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J AmDiet Assoc. 2010;110(4):600–7.
24. • Stephenson, G.D.; Rose, D.P. Breast cancer and obesity: an update. Nutr Cancer. 2003;45(1):1-16. Review. PubMed PMID: 12791499.
25. • van Rutte, P.W.; Aarts, E.O.; Smulders, J.F.; Nienhuijs, S.W. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014 Oct;24(10):1639-46. doi: 10.1007/s11695-014-1225-y
26. • www.who.int/topics/obesity/en/ (date of access 10.01.2021)