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

Background: Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric sur-gery. 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 histopath-ologic series in SG patients yet reported. Objective: 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. Setting: University hospital. Methods: A retrospective electronic chart review of patients who underwent SG at a single large ac-ademic institution was performed. Patient demographics, body mass index, and histopathologic re-ports of the gastric specimens obtained during SG were analyzed. Results: The records of 3543 patients were reviewed. A total of 1076 patients had abnormal pathol-ogies, 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 meta-plasia. A higher incidence of Helicobacter pylori infection among specimens with abnormal pathol-ogies was noted. Conclusions: 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. (Surg Obes Relat Dis 2023;19:283-288.) (c) 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.