Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?

AbdullGaffar, Badr; Raman, Lakshmiah G.; Khamas, Ali; Al-Badri, Faisal

doi:10.1007/s11695-015-1726-3

Cited by 40 publications

(36 citation statements)

References 26 publications

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“…First, most research explored the clinical aspects, surgical techniques, and postoperative complications of LSG [6], with few studies examining the histopathologic outcomes, resulting in a scarcity of data about gastric histopathologic changes in LSG patients [7]. Second, while LSG patients may be presumed to have no significant gastric pathology, the literature is highly inconsistent as whether this is usually the case.…”

Section: Introductionmentioning

confidence: 99%

“…In the USA, 8.4% of cases had unforeseen findings necessitating clinical follow-up [8]; in Kuwait, no normal specimens were reported, and 74.4% of the 656 LSG specimens had element/s of chronic gastritis [9]; and in New Zealand, >50% of the LSG specimens demonstrated histopathologic abnormality [10]. Conversely, others found that most post LSGs had no pathologic alteration, that a minority had significant pathologic findings [7, 11], and that routine microscopic examination of LSG specimens was unnecessary [6]. …”

Section: Introductionmentioning

confidence: 99%

“…In addition, there is a paucity of research on gastric histopathologic changes of morbidly obese LSG patients across the eastern Mediterranean countries, except for Saudi Arabia [12], Kuwait [9], and United Arab Emirates [6]. Furthermore, most of the scarce published literature on histopathologic changes in morbidly obese LSG patients investigated modest sample sizes, e.g., 87 patients [13], 145 patients [7], or 248 patients [8], with the larger studies comprising 310 [11] or 656 patients [9].…”

Section: Introductionmentioning

confidence: 99%

“…Finally, while some risk factors (e.g., gender, age, and Helicobacter pylori infection) seem associated with specific abnormal histopathologic changes in general populations [14–23], these risk factors have not been examined across samples of LSG patients. Unsurprisingly, there still remains much debate as to whether routine histopathologic examination of LSG specimens is required, with support [9] or nonsupport [6] for such routine examination.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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BackgroundLaparoscopic 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.MethodsRetrospective 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.ResultsMean 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).ConclusionOlder 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…A recent prospective study by Abdullgaffar and colleagues [15] calls into question the utility of routine microscopic examination of all laparoscopic sleeve gastrectomy specimen. Based on < 1% incidence of benign lesions and no malignant lesions identified in 546 specimens, they advocate special gross handling protocols and meticulous macroscopic evaluation with selective microscopic examination only, for the benefit of cost and time effectiveness whilst demonstrating no major compromise to patient safety.…”

Section: Case Reportmentioning

confidence: 99%

Laparoscopic Sleeve Gastrectomy - An Unexpected Finding: MALT Lymphoma in a H.Pylori-Negative Patient

Silva¹

2017

Int J Surg Res Pract

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at the posterior wall, involving the mucosa and muscularis propria of the fundus, and extending anteriorly by 60 × 25 mm ( Figure 1). The fundal lesion consisted of a diffuse lymphoid infiltrate from the mucosa to the muscularis propria. Atypical small to intermediate cells were noted on microscopy with occasional lymphoepithelial lesions and residual reactive follicular centres. An area of necrosis within the tumour was also identified. Lymphoid immunoperoxidase staining demonstrated: CD20 and bcl2: positive CD5, CD10, CD23, bcl6 and cyclin D1: negative Ki-67 proliferative index of 5% Helicobacter pylori (H. pylori) stain: negative.A diagnosis of extranodal marginal zone B cell lymphoma of MALT (Mucosa Associated-Lymphoid Tissue) type was confirmed.Post-operatively, the patient was reviewed by a hematologist who noted her to have been asymptomatic prior to the operation but for a single episode of non-specific dysphagia and upper abdominal pain. Clinical examination revealed no lymphadenopathy or hepatosplenomegaly. Lymphoma staging with computed tomography did not show clear evidence of local spread or distal lymphadenopathy. Full blood panel was within normal limits. Peripheral blood smear did not show any evidence of lymphoproliferative disorders. Post-operative urea breath testing for H. pylori was negative. Following multidisciplinary evaluation, she was placed onto a twice yearly endoscopic surveillance program, of which the two most recent surveillance results demon- AbstractOverweight and Obesity have been associated with an increased risk of developing a variety of gastrointestinal cancers [1]. The increasing implementation of bariatric surgery to manage overweight and obesity would likely increase the incidental diagnosis of malignancies in patients who were previously asymptomatic or had nonspecific gastrointestinal symptoms. We present the case of a MALT gastric lymphoma incidentally diagnosed on histopathology following laparoscopic sleeve resection for obesity. KeywordsGastrectomy, Bariatric surgery, Obesity, Lymphoma, Gastrointestinal tumour CASE REPORT Case ReportA 59-year-old female underwent standard laparoscopic gastric sleeve resection following failure of diet and medical management for obesity (weight, 121.4 kg; BMI, 45 kg/m 2 ). Comorbidities included hypertension, hyper triglyceridaemia and insulin resistance. Routine preoperative workup including upper gastrointestinal ultrasound, and barium swallow were unremarkable.Following routine 5 port optical entry, the greater curvature vessels were divided. The sleeve resection was performed using an Endo GIA Tristapler (Medtronic, Minneapolis). The staple line was reinforced with seamguard and imbricated proximally with 3.0 Prolene sutures. There were no intra-operative complications. Macroscopic evaluation of the resected gastric specimen revealed an elevated mass measuring 180 × 30 mm

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Endoscopists and Surgeons Playing in the Same Team: The Multidisciplinary Approach in Screening and Preoperative Workup

Mathus-Vliegen

Dargent²

2018

Bariatric Therapy

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Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?

Cited by 40 publications

References 26 publications

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

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

Laparoscopic Sleeve Gastrectomy - An Unexpected Finding: MALT Lymphoma in a H.Pylori-Negative Patient

Endoscopists and Surgeons Playing in the Same Team: The Multidisciplinary Approach in Screening and Preoperative Workup

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