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12.03.2024 | Original Contributions

Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience

verfasst von: Christopher K. Owen, Melissa M. Felinski, Kulvinder S. Bajwa, Peter A. Walker, Sheilendra S. Mehta, Erik B. Wilson, Stefanie Boodoo, Vishal Kudav, Shaan J. Akhtar, Shinil K. Shah, M. Elaine Kling

Erschienen in: Obesity Surgery | Ausgabe 5/2024

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Abstract

Introduction

Endoscopy prior to bariatric surgery is not always performed, and in sleeve gastrectomy (SG), the surgical specimen is not always sent for pathological examination. There is limited data on the frequency of clinically significant findings in SG specimens or correlation with preoperative endoscopy.

Methods

We reviewed 426 consecutive SG patients to determine the concordance of preoperative endoscopy findings in patients with clinically significant postoperative pathology.

Results

Preoperative endoscopy was performed on 397 patients (93.2%). Three hundred seventy-three patients had preoperative endoscopy and surgical pathology results available. Then, 20/373 (5.4%) patients had potentially significant postoperative pathology, including intestinal metaplasia, autoimmune metaplastic atrophic gastritis (AMAG), gastrointestinal stromal tumors, and/or gastric cancer. The overall incidence of AMAG in the entire cohort was 2.3%. Preoperative gastric biopsies (to include gastric body) identified AMAG in nearly 1/2 of patients. Patients with clinically significant postoperative pathology results had a median [interquartile range] of 3 [3–5] tissue blocks examined as compared to 3 [1–3] for the remainder of the cohort (p < 0.001).

Conclusion

This is one of the largest studies describing clinically significant postoperative pathology after SG. AMAG, in particular, is of particular importance as it is associated with a 3–fivefold increase in risk for gastric cancer. The incidence of significant postoperative pathology in this population is small but potentially clinically significant and requires validation in larger studies. We recommend wider sampling in preoperative endoscopy (body and antrum), especially in patients being planned for gastric bypass, consideration for routine pathological examination of SG surgical specimens, with careful gross examination and targeted sampling.

Graphical Abstract

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Titel: Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience
verfasst von: Christopher K. Owen
Melissa M. Felinski
Kulvinder S. Bajwa
Peter A. Walker
Sheilendra S. Mehta
Erik B. Wilson
Stefanie Boodoo
Vishal Kudav
Shaan J. Akhtar
Shinil K. Shah
M. Elaine Kling
Publikationsdatum: 12.03.2024
Verlag: Springer US
Erschienen in: Obesity Surgery / Ausgabe 5/2024
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07155-y

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Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience