Surgical Endoscopy

, Volume 33, Issue 12, pp 4003–4007 | Cite as

Pathologic findings of the removed stomach during sleeve gastrectomy

  • Li Ge
  • Rena C. Moon
  • Ha Nguyen
  • Luiz Gustavo de Quadros
  • Andre F. Teixeira
  • Muhammad A. JawadEmail author



Laparoscopic sleeve gastrectomy (LSG) is the preferred surgical intervention to treat morbid obesity. Despite the rising popularity of LSG, little is known on the histopathologic findings of the resected partial stomach specimens. Our study aims to identify prevalent pathologic findings of the removed stomach and explore the association between patient characteristics and abnormal findings.


A retrospective analysis was conducted using a prospectively maintained database of 649 patients who underwent LSG between November 1, 2013 and December 31, 2015 at our institution. Patient characteristics included age, body mass index, gender, and preoperative comorbidities (diabetes, hyperlipidemia, depression, gastroesophageal reflux, hypertension, and sleep apnea). Statistical analysis was performed using descriptive analysis and logistic regression models.


Abnormal pathologic findings were identified in approximately one-fifth (n = 142, 21.9%) of the patients. The most common find is non-specific chronic gastritis (9.7%), followed by Helicobacter pylori gastritis (4.9%). Approximately 15% of patients had significant histopathological alterations that might require further investigation, treatment, or follow-up, including non-specific chronic gastritis, H. pylori gastritis, autoimmune atrophic gastritis, and gastrointestinal stromal tumor. The odds of abnormal findings in patients without hyperlipidemia was 0.09 times the corresponding odds in those with hyperlipidemia (95% CI 0.03–0.29), controlling for factors including age, body mass index, gender, and other preoperative comorbidities.


Patients with gastroesophageal reflux and hyperlipidemia might suggest higher incidence rate of gastric histopathologic abnormalities. Routine preoperative screening may not be beneficial for patients undergoing sleeve gastrectomy.


Sleeve gastrectomy Pathology Stomach 


Compliance with ethical standards


Dr. Andre Teixeira is a consultant for Intuitive Surgical and Ethicon Endo-Surgery. Dr. Muhammad Jawad is a consultant for Ethicon Endo-Surgery. Dr. Li Ge, Dr. Rena Moon, Dr. Ha Nguyen, and Dr. Gustavo Quadros have no conflicts of interest or financial ties to disclose.


  1. 1.
    World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Kit BK et al (2014) Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311:806–814CrossRefGoogle Scholar
  3. 3.
    Raess PW, Baird-Howell M, Aggarwal R et al (2015) Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Relat Dis 11:1020–1024CrossRefGoogle Scholar
  4. 4.
    Deitel M, Gagner M, Erickson AL et al (2011) Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis 7:747–759Google Scholar
  5. 5.
    Rawlins L, Rawlins MP, Brown CC et al (2013) Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 9:21–25CrossRefGoogle Scholar
  6. 6.
    Behrens C, Tang BQ, Amson BJ (2011) Early results of a Canadian laparoscopic sleeve gastrectomy experience. Can J Surg 54:138–143CrossRefGoogle Scholar
  7. 7.
    Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436CrossRefGoogle Scholar
  8. 8.
    Nguyen NT, Nguyen B, Gebhart A, Hohmann S (2013) Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg 216:252–257CrossRefGoogle Scholar
  9. 9.
    Ohanessian SE, Rogers AM, Karamchandani DM (2016) Spectrum of gastric histopathologies in severely obese American patients undergoing sleeve gastrectomy. Obes Surg 26:595–602CrossRefGoogle Scholar
  10. 10.
    Almazeedi S, Al-Sabah S, Al-Mulla A et al (2013) Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg 23:314–319CrossRefGoogle Scholar
  11. 11.
    AbdullGaffar B, Raman L, Khamas A et al (2016) Should we abandon routine microscopic examination in bariatric sleeve gastrectomy specimens? Obes Surg 26:105–110CrossRefGoogle Scholar
  12. 12.
    Lauti M, Gormack S, Thomas J et al (2016) What does the excised stomach from sleeve gastrectomy tell us? Obes Surg 26:839–842CrossRefGoogle Scholar
  13. 13.
    Clapp B (2015) histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS 19:1–3Google Scholar
  14. 14.
    Raess PW, Baird-Howell M, Aggarwal R et al (2013) What’s up my sleeve? High prevalence of unexpected histopathologic findings in vertical sleeve gastrectomy specimens. Mod Pathol 26:173AGoogle Scholar
  15. 15.
    Rojas CP, Bullock N, Parikh JG et al (2016) Sleeve gastrectomy: unanticipated findings in the pathology review. More than anyone expects. Lab Invest 96:196AGoogle Scholar
  16. 16.
    Moon RC, Teixeira AF, Jawad MA (2015) Is preoperative manometry necessary for evaluation reflux symptoms in sleeve gastrectomy patients? Surg Obes Relat Dis 11:546–551CrossRefGoogle Scholar
  17. 17.
    Loy CT, Irwig LM, Katelaris PH, Talley NJ (1996) Do commercial serologic kits for Helicobacter pylori infection differ in accuracy? A meta-analysis. Am J Gastroenterol 91:1138–1144PubMedGoogle Scholar
  18. 18.
    Testerman TL, Morris J (2014) Beyond the stomach: an updated view of Helicobater pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol 20:12781–12808CrossRefGoogle Scholar
  19. 19.
    Malfertheiner P, Megraud F, O’Morain CA et al (2012) Management of Helicobacter pylori infection—the Maastricht IV/Florence Consensus Report. Gut 61:646–664CrossRefGoogle Scholar
  20. 20.
    Duck WM, Sobel J, Pruckler JM et al (2004) Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States. Emerg Infect Dis 10:1088–1094CrossRefGoogle Scholar
  21. 21.
    Miller GC, Reid AS, Brown IS (2016) The pathological findings seen in laparoscopic sleeve gastrectomies for weight loss. Pathology 48:228–232CrossRefGoogle Scholar
  22. 22.
    Benjamin Clapp (2015) Histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS 19:e2013.00259CrossRefGoogle Scholar
  23. 23.
    Kinsinger LA, Garber JC, Whipple O (2016) A review of sleeve gastrectomy specimen histopathology. Am Surg 82:1101–1104PubMedGoogle Scholar
  24. 24.
    Hansen SK, Pottorf BJ, Hollis HW Jr, Rogers JL, Husain FA (2017) Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy? Am J Surg 214:1151–1155CrossRefGoogle Scholar
  25. 25.
    Danciu M, Simion L, Poroch V et al (2016) The role of histological evaluation of Helicobacter pylori infection in obese patients referred to laparoscopic sleeve gastrectomy. Rom J Morphol Embryol 57:1303–1311PubMedGoogle Scholar
  26. 26.
    Viscido G, Signorini F, Navarro L, Campazzo M, Saleg P, Gorodner V, Obeide L, Moser F (2017) Incidental finding of gastrointestinal stromal tumors during laparoscopic sleeve gastrectomy in obese patients. Obes Surg 27:2022–2025CrossRefGoogle Scholar
  27. 27.
    Kopach P, Genega EM, Shah SN, Kim JJ3, Suarez Y (2017) The significance of histologic examination of gastrectomy specimens: a clinicopathologic study of 511 cases. Surg Obes Relat Dis 13:463–467CrossRefGoogle Scholar
  28. 28.
    Kwiecien S, Ptak-Belowska A, Krzysiek-Maczka G et al (2012) Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, interacts with gastric oxidative metabolism and enhances stress-induced gastric lesions. J Physiol Pharmacol 63:515PubMedGoogle Scholar
  29. 29.
    Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Sherman A, Ren CJ (2004) Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg 14:1367–1372CrossRefGoogle Scholar
  30. 30.
    Munoz R, Ibanez L, Salinas J et al (2009) Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg 19:427–431CrossRefGoogle Scholar
  31. 31.
    Csendes A, Burgos AM, Smok G, Beltan M (2007) Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg 17:28–34CrossRefGoogle Scholar
  32. 32.
    Kuper MA, Kratt T, Kramer KM et al (2010) Effort, safety, and findings or routine preoperative evaluation of morbidly obese patients undergoing bariatric surgery. Surg Endosc 24:1996–2001CrossRefGoogle Scholar
  33. 33.
    SAGES Guidelines Committee (2009) SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Obes Relat Dis 5:387–405CrossRefGoogle Scholar
  34. 34.
    Loewen M, Giovanni J, Barba C (2008) Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis 4:709–712CrossRefGoogle Scholar
  35. 35.
    Peromaa-Haavisto P, Victorzon M (2013) Is routine preoperative upper GI endoscopy needed prior to gastric bypass? Obes Surg 23:736–739CrossRefGoogle Scholar
  36. 36.
    De Palma GD, Forestieri P (2014) Role of endoscopy in the bariatric surgery of patients. World J Gastroenterol 20:777–784Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PathologyOrlando Regional Medical Center, Orlando HealthOrlandoUSA
  2. 2.Department of Bariatric SurgeryOrlando Regional Medical Center, Orlando HealthOrlandoUSA
  3. 3.Department of Bariatric EndoscopyKaiser Day HospitalSão José do Rio PretoBrazil

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