G2 Insider: Histopathologic Review Important With Bariatric Surgery Specimens
Histopathological review of resections from gastric sleeve resections is necessary as unexpected, clinically significant pathology may be found, according to an abstract presented at the College of American Pathologists annual meeting (Chicago; Sept. 7-10). In a recent case review study, nearly one-quarter of bariatric surgery patients had a clinically significant finding, which the authors say […]
Histopathological review of resections from gastric sleeve resections is necessary as unexpected, clinically significant pathology may be found, according to an abstract presented at the College of American Pathologists annual meeting (Chicago; Sept. 7-10). In a recent case review study, nearly one-quarter of bariatric surgery patients had a clinically significant finding, which the authors say is noteworthy for better informing the discussion of standardizing preoperative workups for these obese patients. The need for preoperative endoscopy is currently debated for patients readying for bariatric surgery. While often routine practice, few studies have examined the histopathologic changes in the bariatric specimens of morbidly obese patients to determine if preoperative endoscopy findings would likely alter the operative plan. In the present study, researchers conducted a retrospective case review of 343 bariatric gastric sleeve surgery cases performed at the University of Illinois Hospital and Health Sciences System (January 2009 to August 2013). More than one-half of the patients had histopathologic findings, with 24.8 percent of these findings reaching clinical significance. The most frequent finding was gastritis (69 percent), including chronic inactive (51 percent of all patients), chronic active (15.4 percent), acute-on-chronic gastritis (2 percent), and associated Helicobacter pylori infection (22.8 percent). Six patients (1.7 percent) had ulcers, with only two of them having a previously documented history of ulcers. Histopathological examination showed that two patients (0.58 percent) had gastrointestinal stromal tumors. Other findings included an unknown recurrence of adenocarcinoma (one patient), one polyp (one patient), a gastric diverticulum (one patient), mucosal and vascular congestion, intestinal metaplasia, hemorrhage, and pyloric stenosis (1 patient). No significant histopathologic changes were seen in one-quarter of patients (n = 85). This review confirms the importance of examining these specimens histologically, because clinically significant lesions may be found, and follow-up treatment may be necessary. Experts say that while a higher rate of endoscopic abnormalities in these patients may be seen, the majority of these findings often do not affect the actual operative management, and therefore a selective approach toward preoperative endoscopy is currently called for (2008 American Society of Gastroenterology guidelines) until further data show otherwise. Rachel Gordezky, M.D., a pathology fellow and lead author of the study, says that one takeaway is that while these specimens are from patients going in for routine, elective procedures, they can commonly contain underlying, unexpected conditions, and the specimens warrant “the same care” in examination as those from patients with known masses.