Skip to main content
SpringerLink
Log in

Histopathological Findings in Turkish Patients Undergoing Sleeve Gastrectomy: Is Histopathologic Examination of Sleeve Gastrectomy Specimens Clinically Important?

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

Sleeve gastrectomy (SG) is a widely used surgical method in the treatment of obesity. This study aimed to reveal the histopathological changes in SG materials and to investigate the prevalence of clinically important lesions requiring follow-up.

Materials and Methods

Three hundred five patients’ data who underwent SG were analyzed. Cases were divided into three groups as normal, chronic inactive gastritis (CIG), and chronic active gastritis (CAG). Age, gender, and body mass index (BMI) of the three groups and the differences in the gastritis parameters of CIG and CAG groups were compared.

Results

Thirty-three patients (10.8%) were in the normal group, 145 (47.5%) were in the CIG group, and 127 (41.6%) were in the CAG group. Preoperative endoscopic examination was performed in all cases, but Helicobacter pylori (HP) treatment was not applied. HP were detected in 39.3%, atrophy in 3.9%, intestinal metaplasia (IM) in 4.9%, and lymphoid follicle (LF) in 30% of the cases. Inflammation, atrophy, IM, LF, and HP were significantly higher in the CAG group. The proton pump inhibitor (PPI)–related changes were seen in 20 cases and it was more frequent in the CIG group. Intramucosal signet ring cell carcinoma was detected in 1 case. Endocrine cell hyperplasia and dysplasia were present in 7 cases with CAG. Multiple grade 1 neuroendocrine tumors were detected in just 1 case.

Conclusion

In our SG specimens, HP and clinically important lesions were significantly higher in the CAG group. Pathological examination should be carefully done as the lesions detected in SG specimens can change patient management.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Schauer PR, Schirmer BD. The surgical management of obesity. In: Schwartz SI, editor. Principles of surgery. 10th ed: New York: McGraw-Hill; 2015. p. 1099.

    Google Scholar 

  2. Boutari C, Mantzoros CSA. update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022;2022(133):155217. https://doi.org/10.1016/j.metabol.2022.155217.

    Article  CAS  Google Scholar 

  3. WHO. Obesity and overweight: The World Health Organisation (WHO) Reports; 2016.

    Google Scholar 

  4. Kluge HHP. Weltgesundheitsorganisation Regionalbüro für Europa. WHO European regional obesity report. 2022;n.d. https://apps.who.int/iris/bitstream/handle/10665/353747/9789289057738-eng.pdf

  5. TUİK, (2020, 04 June) Türkiye Sağlık Araştırması Ankara: Türkiye İstatistik Kurumu Sayı: 2019;33661. https://data.tuik.gov.tr/Bulten/Index?p=Turkey-Health-Survey-2019-33661

  6. Barak N, Ehrenpreis ED, Harrison JR, et al. Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev. 2002;3:9–15.

    Article  CAS  PubMed  Google Scholar 

  7. Fujimoto A, Hoteya S, Iizuka T, et al. Obesity and gastrointestinal diseases. Gastroenterol Res Pract. 2013;2013:760574.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wu JC, Mui IM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9.

    Article  PubMed  Google Scholar 

  9. Ogorek CP, Cohen S. Gastroesophageal reflux disease: new concepts in pathophysiology. Gastroenterol Clin North Am. 1989;18:275–92.

    Article  CAS  PubMed  Google Scholar 

  10. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–96.

    Article  Google Scholar 

  11. Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23(12):2013–7.

    Article  PubMed  Google Scholar 

  12. Komaei I, Currò G, Mento F, et al. 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):1339–46.

    Article  PubMed  Google Scholar 

  13. Almazeedi AS, Al-Sabah S, Al-Mulla A, Al-Murad A, Al-Mossawi A, Al-Enezi K, Jumaa T, Bastaki W. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg. 2013;23(3):314–9. https://doi.org/10.1007/s11695-012-0821-y.

  14. Turan G, Kocaöz S. Helicobacter pylori infection prevalence and histopathologic findings in laparoscopic sleeve gastrectomy. Obes Surg. 2019;29(11):3674–9. https://doi.org/10.1007/s11695-019-04052-7.

    Article  PubMed  Google Scholar 

  15. Safaan T, Bashah M, El Ansari W, et al. Histopathological changes in laparoscopic sleeve gastrectomy specimens: prevalence, risk factors, and value of routine histopathologic examination. Obes Surg. 2017;27:1741–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Canil AM, Lossa A, Termine P, et al. Histopathology findings in patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2018;28(6):1760–5.

    Article  PubMed  Google Scholar 

  17. Erkinuresin T, Demirci H, Cayci HM, et al. The relationship between histopathologic findings and weight loss in laparoscopic sleeve gastrectomy. Obes Surg. 2020;30(2):478–82. https://doi.org/10.1007/s11695-019-04185-9.

    Article  PubMed  Google Scholar 

  18. Ohanessian SE, Rogers AM, Karamchandani DM. Spectrum of gastric histopathologies in severely obese American patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(3):595–602.

    Article  PubMed  Google Scholar 

  19. Raess PW, Baird-Howell M, Aggarwal R, et al. Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Rel Dis. 2015;11(7):1020–4.

    Article  Google Scholar 

  20. Taha-Mehlitz S, Mongelli F, Sykora M, et al. Routine histopathologic examination of the resected specimen after laparoscopic sleeve gastrectomy – what can be expected? Acta Chir Belg. 2021;121(6):380–5. https://doi.org/10.1080/00015458.2020.1794335.

    Article  PubMed  Google Scholar 

  21. Demirbaş BT, Erdim A, Celikel C, et al. Is it necessary to send the sleeve gastrectomy specimens to pathology? Surg Laparosc Endosc Percutan Tech. 2019;29:117–9.

    Article  PubMed  Google Scholar 

  22. Al Saady R, Ejeckam G. Histopathological findings in laparoscopic sleeve gastrectomy specimens. Qatar Med J. 2019;2019(1):5. https://doi.org/10.5339/qmj.2019.5.19.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kopach P, Genega EM, Shah SN, et al. The significance of histologic examination of gastrectomy specimens: a clinicopathologic study of 511 cases. Surg Obes Relat Dis. 2017;13:463–7.

    Article  PubMed  Google Scholar 

  24. Doğan U, Süren D, Oruç MT, et al. Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy. Eur Rev Med Pharmacol Sci. 2017;21(23):5430–6.

    PubMed  Google Scholar 

  25. Sabbah NA, Saoud CZ, Deeb M, et al. Helicobacter pylori prevalence in laparoscopic sleeve gastrectomy specimen. Gastroenterol Res Pract. 2020;10(2020):8843696. https://doi.org/10.1155/2020/8843696.

    Article  Google Scholar 

  26. Di Palma A, Alhabdan S, Maeda A, et al. Unexpected histopathological findings after sleeve gastrectomy [published online September 11, 2019]. Surg Endosc. 2020;34(5):2158–63. https://doi.org/10.1007/s00464-019-07002-7.

    Article  PubMed  Google Scholar 

  27. Aljerian K. Histopathological findings in laparoscopic sleeve gastrectomy specimens from patients with obesity in Saudi Arabia. Gastroenterol Res Pract. 2018;2018:1–4. https://doi.org/10.1155/2018/1702705.

    Article  Google Scholar 

  28. Hansen SK, Pottorf BJ, Hollis Jr H, et al. Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy? Am J Surg. 2017;214(6):1151–5.

    Article  CAS  PubMed  Google Scholar 

  29. Nowak K, Di Palma A, Chieu K, et al. Histologic and cost-benefit analysis of laparoscopic sleeve gastrectomy specimens performed for morbid obesity. Arch Pathol Lab Med. 2021;145(3):365–70. https://doi.org/10.5858/arpa.2020-0084-OA.

    Article  PubMed  Google Scholar 

  30. Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori infection. Helicobacter. 2014;1:1–5.

    Article  Google Scholar 

  31. Mentis A, Lehours P, Mégraud F. Epidemiology and diagnosis of helicobacter pylori infection. Helicobacter. 2015;20:1–7.

    Article  PubMed  Google Scholar 

  32. Shanti H, Almajali N, Al-Shamaileh T, et al. Helicobacter pylori does not affect postoperative outcomes after sleeve gastrectomy. Obes Surg. 2017;27(5):1298–301.

    Article  PubMed  Google Scholar 

  33. Gonzalez-Heredia R, Tirado V, Patel N, et al. Is Helicobacter pylori associated with an increased complication rate after sleeve gastrectomy? Bariatr Surg Pract Patient Care. 2015;10(1):15–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Khatoon J, Rai RP, Prasad KN. Role of Helicobacter pylori in gastric cancer: updates. World J Gastrointest Oncol. 2016;8(2):147–58.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Huang TC, Lee CL. Diagnosis, treatment, and outcome in patients with bleeding peptic ulcers and Helicobacter pylori infections. Biomed Res Int. 2014;2014:658108.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Correa P. A human model of gastric carcinogenesis. Cancer Res. 1988;48:3554–60.

    CAS  PubMed  Google Scholar 

  37. Correa P, Piazuelo MB, Wilson KT. Pathology of gastric intestinal metaplasia: clinical implications. Am J Gastroenterol. 2010;105:493–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Leung W, Sung J. Intestinal metaplasia and gastric carcinogenesis. Aliment Pharmacol Ther. 2002;16(7):1209–16.

    Article  CAS  PubMed  Google Scholar 

  39. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64:1353–67.

    Article  PubMed  Google Scholar 

  40. Vrabie CD, Cojocaru M, Waller M, et al. The main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy. Dicle Med J. 2010;37:97–103.

    Google Scholar 

  41. Odze RD, Goldblum JR. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Philadelphia (PA): Saunders-Elsevier; 2014. p. 361.

    Google Scholar 

  42. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97(4):934–59.

    Article  PubMed  Google Scholar 

  43. Mottin CC, Cruz RP, Gomes Thomé G, et al. Carcinoid tumors and morbid obesity. Obes Surg. 2009;19(2):247–9.

    Article  PubMed  Google Scholar 

  44. Al-Harbi O, Shakir M, Al-Brahim N. Gastric carcinoid and obesity: association or coincidence? Report of two cases and literature review. Case Rep Gastrointest Med. 2013;2013:848075.

    PubMed  PubMed Central  Google Scholar 

  45. Sauerland S, Angrisani L, Belachew M, et al. European Association for Endoscopic Surgery. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19(2):200–21. https://doi.org/10.1007/s00464-004-9194-1.

    Article  CAS  PubMed  Google Scholar 

  46. SAGES Guidelines Committee. SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Obes Relat Dis. 2009;5(3):387–405. https://doi.org/10.1016/j.soard.2009.01.010.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pathology Department, Health Sciences University Bagcilar Training and Research Hospital, Istanbul, Turkey

    Hüsniye Esra Paşaoğlu, Tevhide Bilgen Özcan, Çiğdem Öztürk, Elif Çelik, Tuğçe Bölme Şavlı & Talar Vartanoğlu

  2. Pathology Department, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey

    Çiğdem Öztürk

  3. Pathology Department, Mardin State Hospital, Mardin, Turkey

    Elif Çelik

  4. Pathology Department, Gaziantep Cengiz Gökçek Maternity and Children’s Hospital, Gaziantep, Turkey

    Tuğçe Bölme Şavlı

  5. General Surgery Department, Istanbul Gaziosmanpasa Medical Park Hospital, Istanbul, Turkey

    Talar Vartanoğlu

Authors
  1. Hüsniye Esra Paşaoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tevhide Bilgen Özcan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Çiğdem Öztürk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elif Çelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tuğçe Bölme Şavlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Talar Vartanoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hüsniye Esra Paşaoğlu.

Ethics declarations

Ethical Approval

Approval was obtained from the institutional ethics committee (ethic approval number is 316). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

• There is no accepted standard protocol for histopathologic examination of sleeve gastrectomy specimens and studies have reported a wide range of findings.

• Inflammation, atrophy, intestinal metaplasia, lymphoid follicle, and HP were significantly higher in the chronic active gastritis group than in the chronic inactive gastritis group.

• Unexpected but clinically important lesions such as neuroendocrine tumor and signet ring cell carcinoma can be detected.

• Pathological examination should be carefully done in sleeve gastrectomy specimens. Application of standard procedures in the pathological examination can contribute to learning the lesions associated with obesity.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paşaoğlu, H.E., Özcan, T.B., Öztürk, Ç. et al. Histopathological Findings in Turkish Patients Undergoing Sleeve Gastrectomy: Is Histopathologic Examination of Sleeve Gastrectomy Specimens Clinically Important?. OBES SURG 33, 2808–2815 (2023). https://doi.org/10.1007/s11695-023-06728-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-023-06728-7

Keywords

Search

Navigation