Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy?

• Published in: The American journal of surgery Vol. 214; no. 6; pp. 1151 - 1155
• Main Authors: Hansen, S.K., Pottorf, B.J., Hollis, H.W., Rogers, J.L., Husain, F.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2017; Elsevier Limited
• Subjects: Abnormalities; Bariatric surgery; Body mass index; Cardiovascular disease; Comorbidity; Confidence intervals; Contingency; Diabetes; Dysplasia; Evaluation; Female; Gastrectomy; Gastrectomy - methods; Gastric remnant pathology; Gastric Stump - pathology; Gastritis; Gastritis - microbiology; Gastritis - pathology; Gastroesophageal reflux; Gastrointestinal surgery; Helicobacter pylori; Humans; Hypertension; Infections; Inflammation; Laparoscopy; Male; Malignancy; Metabolism; Middle Aged; Obesity; Obesity co-morbidity; Obesity, Morbid - surgery; Pathology; Patients; Retrospective Studies; Sleep apnea; Sleeve gastrectomy; Statistical analysis; Stomach Diseases - microbiology; Stomach Diseases - pathology; Surgeons; Tumors; Unnecessary Procedures; Weight control; Gastric remnant pathology; Obesity co-morbidity; Bariatric surgery; Sleeve gastrectomy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.06.029

This study attempts to determine if enough pathological abnormalities in gastric remnants from sleeve gastrectomy exist to warrant full pathologic evaluation in all remnants.
Data was collected on patients undergoing sleeve gastrectomy between 08/01/2011 and 06/30/2014. Significant abnormalities were classified as any pathology that might require follow-up or treatment beyond standard follow-up. Age, comorbidities, gender, and Helicobacter pylori titers were analyzed and compared with pathology specimens using 95% confidence intervals and Phi contingency coefficients.
Full pathologic evaluation was available for 351/387 patients (91.2%). No examples of malignancy or dysplasia were identified. Gastritis was the most common abnormality. There was a statistically significant association between preoperative H. pylori and significantly abnormal pathology (p = 0.003). Other comorbidities had no association.
These results suggest that full pathologic evaluation of the gastric remnant following sleeve gastrectomy is unnecessary, particularly when gross pathology is not noted at initial operation.