Histopathologic findings in laparoscopic sleeve gastrectomy: is routine full pathologic evaluation indicated?

Published:October 06, 2022DOI:



      Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric surgery. The resected gastric segment is routinely sent for pathology evaluation. No formal national recommendation exists that mandates pathology review. We proposed to study the largest histopathologic series in SG patients yet reported.


      The primary objective of our study was to determine whether a subgroup of patients who underwent bariatric surgery in the northeastern Unites States is more susceptible to having clinically significant pathologic findings that may benefit from routine histopathologic evaluation of the gastric sleeve specimen.


      University hospital.


      A retrospective electronic chart review of patients who underwent SG at a single large academic institution was performed. Patient demographics, body mass index, and histopathologic reports of the gastric specimens obtained during SG were analyzed.


      The records of 3543 patients were reviewed. A total of 1076 patients had abnormal pathologies, including gastritis (938), follicular gastritis (98), intestinal metaplasia (25), gastrointestinal stromal tumor (12), leiomyoma (1), lymphoma (1), and other malignancy (1). Black and Hispanic patients had a higher incidence of developing gastrointestinal stromal tumor and intestinal metaplasia. A higher incidence of Helicobacter pylori infection among specimens with abnormal pathologies was noted.


      The findings of this study call into question the routine use of pathology workup in gastric specimens after SG. Our data suggest that such analysis may be warranted in certain subtypes of patients such as older Black and Hispanic patients in the northeastern United States.


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      1. Public Education Committee. Benefits of weight loss surgery. American Society for Metabolic and Bariatric Surgery [Internet]. 2020 Sep [cited 2022 Aug 19];[about 2 p.]. Available from:

        • Ozsoy Z.
        • Demir E.
        Which bariatric procedure is the most popular in the world? A bibliometric comparison.
        Obes Surg. 2018; 28 (erratum in Obes Surg 2018;28(8):2353): 2339-2352
        • Guerrier J.B.
        • Dietch Z.C.
        • Schirmer B.D.
        • Hallowell P.T.
        Laparoscopic sleeve gastrectomy is associated with lower 30-day morbidity versus laparoscopic gastric bypass: an analysis of the American College of Surgeons NSQIP.
        Obes Surg. 2018; 28: 3567-3572
      2. Chan T, Patel S, Mehran A. Routine preoperative EGD, UGI, and H. pylori screening: are they necessary? Bariatric Times [serial on the Internet]. 2011 Mar [cited 2022 Jun 12]; 8(3):[about 3 p.]. Available from:

        • Campos G.M.
        • Mazzini G.S.
        • Altieri M.S.
        • et al.
        ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery.
        Surg Obes Relat Dis. 2021; 17: 837-847
        • Khaldoon A.
        Histopathological findings in laparoscopic sleeve gastrectomy specimens from patients with obesity in Saudi Arabia.
        Gastroenterol Res Pract. 2018; 20181702705
        • Clapp B.
        Histopathologic findings in the resected specimen of a sleeve gastrectomy.
        JSLS. 2015; 19e2013.00259
        • Vhriterhire R.A.
        • Ngbea J.A.
        • Akpor I.O.
        • et al.
        Clinicopathological diagnostic discrepancies: an analysis of 1703 surgical pathology specimens.
        Ann Trop Pathol. 2018; 9: 50
        • Safaan T.
        • Basha M.
        • Ansari W.
        • Karam M.
        Histopathological changes in laparoscopic sleeve gastrectomy specimens: prevalence, risk factors, and value of routine histopathologic examination.
        Obes Surg. 2017; 27: 1741-1749
        • Raess P.W.
        • Baird H.
        • Aggarwal R.
        • Williams N.
        • Furth E.
        Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management.
        Surg Obes Relat Dis. 2015; 11: 1020-1023
      3. American Society of Clinical Oncology. Gastrointestinal stromal tumor – GIST: statistics. Cancer.Net [Internet]. 2022 Feb [cited 2022 Jun 12];[about 1 p.]. Available from:

        • Banks M.
        • Graham D.
        • Jansen M.
        • et al.
        British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma.
        Gut. 2019; 68: 1545-1575
      4. American Society of Clinical Oncology. Gastrointestinal stromal tumor – GIST: risk factors. Cancer.Net [Internet]. 2021 Aug [cited 2022 Jan 19];[about 1 p.]. Available from:

        • Jiang J.-X.
        • Liu Q.
        • Zhao B.
        • et al.
        Risk factors for intestinal metaplasia in a southeastern Chinese population: an analysis of 28,745 cases.
        J Cancer Res Clin Oncol. 2016; 143: 409-418
        • Sonnenberg A.
        • Turner K.
        • Genta R.
        Low prevalence of Helicobacter pylori–positive peptic ulcers in private outpatient endoscopy centers in the United States.
        Am J Gatroenterol. 2020; 115: 244-250
        • Novis B.H.
        • Gabay G.
        • Naftali T.
        Helicobacter pylori: the Middle East scenario.
        Yale J Biol Med. 1998; 71: 135-141
        • Naylor G.M.
        • Gotoda T.
        • Dixon M.
        • et al.
        Why does Japan have a high incidence of gastric cancer? Comparison of gastritis between UK and Japanese patients.
        Gut. 2006; 55: 1545-1552
        • Fukao A.
        • Hisamichi S.
        • Fujino N.
        • Endo N.
        • Iha M.
        Correlation between the prevalence of gastritis and gastric cancer in Japan.
        Cancer Causes Control. 1993; 4: 17-20

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      • Comment on: Histopathologic findings in laparoscopic sleeve gastrectomy: is routine full pathologic evaluation indicated?
        Surgery for Obesity and Related Diseases
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          The empiric gross and histologic pathology examination of sleeve gastrectomy specimens has come under progressively increasing scrutiny. The authors of this article [1] make a valid point that identification of abnormal gastric pathology is a key component of providing excellence in care to the bariatric surgical patient. They demonstrate findings of previously undiagnosed malignancy in a tiny portion of patients, but more importantly, statistically significant amounts of previously undiagnosed gastritis and Heliobacter pylori infections.
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