Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy.
Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Obes Surg. 2020 Apr;30(4):1339-1346. doi: 10.1007/s11695-019-04272-x.
The value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up.
Clinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings.
Chronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000).
Histopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.
腹腔镜袖状胃切除术（LSG）后切除胃残端的常规组织病理学检查的价值仍存在争议。本研究旨在确定如果在上消化道内镜（UGIE）检查期间常规进行多次活检，则对所有接受 LSG 的患者是否需要对胃标本进行常规组织病理学检查。
分析了 474 例接受 LSG 患者的临床病理数据。估计 LSG 标本的组织病理学发现类型以及这些发现和幽门螺杆菌（HP）感染的发生率。进行了比较，以评估危险因素与最常见的异常和癌前组织病理学发现之间的关联。
慢性胃炎是最常见的胃病理学改变（63.5%），且标本中存在癌前病变占 7.8%。HP 感染的患病率为 36.9%。HP 感染与慢性胃炎（P=0.000）和癌前病变（P=0.000）之间存在统计学显著关联。同样，年龄与癌前胃病变之间也存在统计学显著关联（P=0.000）。
LSG 标本的组织病理学检查可能不是常规需要的，可以在选择的患者中进行。虽然我们建议对所有接受 LSG 治疗的患者进行常规术前 UGIE，但我们建议在 UGIE 活检显示 HP 感染和/或癌前病变、所有年龄大于 42 岁的患者、以及术中发现偶然肿瘤或可疑病变时，应强制性地对 LSG 标本进行组织病理学评估。
