Abstract
Purpose
The most important cause affecting the thickness of the gastric wall other than the tumor is chronic gastritis caused by Helicobacter pylori (Hp), which is most frequently detected in the antrum. This study aims to investigate the effect of bismuth-based treatment (BBT) combined with proton pump inhibitor (PPI) on wall thicknesses measured in the postoperative gastric specimen and early postoperative complications in patients with Hp-positive pre-LSG endoscopic gastric biopsies.
Materials and Methods
The patients who underwent LSG procedure for morbid obesity were divided into three groups as follows: Hp-negative, Hp-positive without eradication treatment, and Hp-positive, and LSG was performed after eradication treatment. Macroscopic and microscopic gastric wall thickness measurements were made at a distance of 1 cm from the proximal surgical margin, from the middle part of the specimen, and 1 cm from the distal surgical margin in the gastric specimen and the results were compared.
Results
A total of 132 patients were included in the study, 44 patients in each group. Microscopically measured antrum mucosal thickness was found to be statistically significantly higher in group 2 compared to other groups (groups 1.15, 1.35, 1.16 mm, respectively, p = 0.000). There was no difference between the groups in terms of early complications such as bleeding, wound site infection, or leakage from the staple line within the first 28 days after surgery.
Conclusion
This study found that LSG had no effect on early complications due to Hp positivity or eradication of Hp.
Key Points
• The presence of HP increases the wall thickness of the gastric antrum mucosa.
• After HP eradication, stomach antrum wall thickness returns to normal.
• HP eradication before LSG reduces the wall thickness of the gastric antrum mucosa.
• It was determined that HP scanning and eradication before LSG had no effect on postoperative complications.
Graphical abstract
![](http://media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs11695-021-05513-8/MediaObjects/11695_2021_5513_Figa_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11695-021-05513-8/MediaObjects/11695_2021_5513_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11695-021-05513-8/MediaObjects/11695_2021_5513_Fig2_HTML.jpg)
Similar content being viewed by others
References
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.
Buchwald H, Oein D. Metabolic/bariatric surgery worldwide. Obes Surg. 2011;23:427–36.
Lazzati A, Guy-Lachuer R, Delaunay V, et al. Bariatric surgery trends in France: 2005–2011. Surg Obes Relat Dis. 2014;10(2):328–34.
Reames BN, Finks JF, Bacal D, et al. Changes in bariatric surgery procedure use in Michigan, 2006-2013. JAMA. 2014;312(9):959–61.
English WJ, DeMaria EJ, Hutter MM, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States Surg Obes Relat Dis. 2020;16(4):457–463.
Rosenthal RJ. International Sleeve Gastrectomy Expert Panel. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.
Aurora A, Khaitan L, Saber A. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.
Knapps J, Ghanem M, Clements J, et al. A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS. 2013;17(3):390–9.
Benedix F, Benedix D, Knoll C, et al. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obes Surg. 2014;24(10):1610–6.
Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14(10):1290–8.
Onzi TR, d’Acampora AJ, de Araújo FM, et al. Gastric histopathology in laparoscopic sleeve gastrectomy: pre- and post-operative comparison. Obes Surg. 2014;24:371–6. https://doi.org/10.1007/s11695-013-1107-8.
Graham DY, Go MF. Helicobacter pylori: current status. Gastroenterology. 1993;105:279–82.
Gelfand DW, Ott DJ. Helicobacter pylori and gastroduodenal diseases: a minor revolution for radiologists. AJR Am J Roentgenol. 1997;168:1421–2.
Pattison CP, Combs MJ, Marshall BJ. Helicobacter pylori and peptic ulcer disease: evolution to revolution to resolution. AJR Am J Roentgenol. 1997;168:1415–20.
Correa P, Houghton JM. Carcinogenesis of Helicobacter pylori. Gastroenterology. 2007;133:659–72.
Axon AT. Helicobacter pylori therapy: effect on peptic ulcer disease. J Gastroenterol Hepatol. 1991;6:131–7.
Sapala JA, Wood MH, Sapala MA, et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8:505–16.
Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21(7):1090–4.
Keren D, Matter I, Rainis T, et al. Sleeve gastrectomy leads to helicobacter pylori eradication. Obes Surg. 2009;19:751–6.
Brownlee AR, Bromberg E, Roslin MS. Outcomes in patients with Helicobacter pylori undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2015; https://doi.org/10.1007/s11695-015-1687-6.
Dooley CP, Cohen H, Fitzgibbons PL, et al. Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med. 1989;321:1562–6.
Kul S, Sert B, Sarı A, et al. Effect of subclinical Helicobacter pylori infection on gastric wall thickness: multislice CT evaluation. Diagn Interv Radiol. 2008;14:138–42.
Malfertheiner P, Megraud F. O Morain C et al. The European Helicobacter pylori Study Group (EHPSG). Current concepts in the management of Helicobacter pylori infection- The Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther. 2002;16:167–80.
Cirak MY, Akyon Y, Megraud F. Diagnosis of Helicobacter pylori. Helicobacter. 2007;12(suppl 1):4–9.
Delaney B, Moayyedi P, Deeks J, et al. The management of dyspepsia: a systematic review. Health Technol Assess. 2000;4:1–189.
Veldhuyzen van Zanten SJ, Flook N, Chiba N, et al. An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori. Canadian Dyspepsia Working Group. CMAJ. 2000;162(suppl 12):S3–S23.
European Helicobacter pylori Study Group. Current European concepts on the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut. 1997;41:8–13.
Huang J, Hunt RH. The importance of clarithromycin dose in the management of Helicobacter pylori infection: a meta-analysis of triple therapies with a proton pump inhibitor, clarithromycin and amoxycillin or metronidazole. Aliment Pharmacol Ther. 1999;13:719–29.
Gisbert JP, Gonzalez L, Calvet X, et al. Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: a meta-analysis of eradication of Helicobacter pylori. Aliment Pharmacol Ther. 2000;14:1319–28.
Van der Wouden EJ, Thijs JC, van Zwet AA, et al. The influence of in vitro nitroimidazole resistance on the efficacy of nitroimidazole-containing anti-Helicobacter pylori regimens: a meta-analysis. Am J Gastroenterol. 1999;94:1751–9.
De Boer WA, Driessen WM, Potters VP, et al. Randomized study comparing 1 with 2 weeks of quadruple therapy for eradicating Helicobacter pylori. Am J Gastroenterol. 1994;89:1993–7.
Houben MH, Van Der Beek D, Hensen EF, et al. A systematic review of Helicobacter pylori eradication therapy—the impact of antimicrobial resistance on eradication rates. Aliment Pharmacol Ther. 1999;13:1047–55.
Rodgers C, van Zanten SV. A meta-analysis of the success rate of Helicobacter pylori therapy in Canada. Can J Gastroenterol. 2007;21(5):295–300.
Filipec Kanizaj T, Katicic M, Skurla B, et al. Helicobacter pylori eradication therapy success regarding different treatment period based on clarithromycin or metronidazole triple-therapy regimens. Helicobacter. 2009;14(1):29–35.
Sun Q, Liang X, Zheng Q, et al. High efficacy of 14-day triple therapy-based, bismuth-containing quadruple therapy for initial Helicobacter pylori eradication Helicobacter. 2010;15(3):233–8.
Urban BA, Fishman EK, Hruban RH. Helicobacter pylori gastritis mimicking gastric carcinoma at CT evaluation. Radiology. 1991;179:689–91.
Elariny H, Gonzalez H, Wang B. Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005;14:119–24.
Susmallian S, Goitein D, Barnea R, et al. Correct evaluation of gastric wall thickness may support a change in staplers’ size when performing sleeve gastrectomy. IMAJ. 2017;19:351–4.
Rawlins L, Rawlins MP, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc. 2014;28:811–4.
Mulisch M, Welsch U. editors. Romeis. Mikroskopische Technik. 18th ed. Heidelberg: Spektrum; 2010.
Yazar FM, Baykara M, Karaagaç M, et al. The role of conventional ultrasonography in the evaluation of antral wall thickness in obese patients. Obes Surg. 2016;26:2995–3000.
Ramaswamy A, Lin E, Ramshaw BJ, et al. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery for morbid obesity. Arch Surg. 2004;139:1094–6.
Cordeiro F, Ferraz E. H. pylori and gastroplasty in the treatment of morbid obesity. Am J Gastroenterol. 2001;96:605–6.
Stellato TA, Crouse C, Hallowell PT. Bariatric surgery creating new challenges for the endoscopist. Gastrointest Endosc. 2003;57:86–94.
Al Hajj GN, Haddad J. Preventing staple-line leak in sleeve gastrectomy: reinforcement with bovine pericardium vs oversewing. Obes Surg. 2013;23(11):1915–21.
Kassir R, Blanc P, Amor IB, et al. Division of the stomach and checking on haemostasis for performing sleeve gastrectomy. Points of controversy. Obes Surg. 2015;25(3):537–8.
Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.
Gagner M. Leaks after sleeve gastrectomy are associated with smaller bougies: prevention and treatment strategies. Surg Laparosc Endosc Percutan Tech. 2010;20(3):166–9.
Chiu S, Birch D, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–5.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy a multicenter experience with 2,834 patients. Surg Endosc. 2012;27(1):240–5.
Endo GIA™ Reloads with Tri-Staple™. Technology Technical Brochure. Available at: www.medtronic.com/content/dam/covidien/library/us/en/product/surgical-stapling/endo-gia-reloadstechnical-brochure.pdf. Accessed: 9 Feb 2017.
GST Bariatric Brochure. Available at: www.ethicon.com/sites/default/files/managed-documents/030235-150225_gst-bariatric-brochure.pdf. Accessed: 9 Feb 2017.
Rossetti G, Moccia F, Marra T, et al. Does helicobacter pylori infection have influence on outcome of laparoscopic sleeve gastrectomy for morbid obesity? Int J Surg. 2014:1e4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Ergin, A., Çiyiltepe, H., Karip, A.B. et al. The Effect of Helicobacter pylori Eradication on Gastric Wall Thickness in Patients Undergoing Laparoscopic Sleeve Gastrectomy. OBES SURG 31, 4024–4032 (2021). https://doi.org/10.1007/s11695-021-05513-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-021-05513-8