Histopathological findings in laparoscopic sleeve gastrectomy specimens and their relation to preoperative endoscopy

Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery. Although it is generally considered safe, a thorough preoperative assessment is essential to minimize the risk of complications. The need for histopathological examination of resected gastric specimens in bariatric surgery remains a subject of debate, particularly regarding the role of preoperative esophagogastroduodenoscopy (EGD). This study aimed to determine the prevalence of histopathological findings in resected specimens following sleeve gastrectomy and to assess their agreement with preoperative EGD findings at a tertiary center. This retrospective cross-sectional study examined patients who underwent LSG between 2009 to 2021. The data included demographics, comorbidities, preoperative EGD findings, and routine postoperative histopathology of the resected specimens. Diagnostic accuracy of preoperative EGD was assessed against resected-specimen histopathology. Among the 954 patients who underwent LSG, 67.1% were female, and 84.7% were Saudi nationals. Abnormal histopathological findings were observed in 45.5% (434/954) of the resected specimens, with gastritis being the predominant finding, present in 98.2% (426/434) of these. Preoperative EGD was performed in a subgroup of 357 patients (37.4%); in these, gastritis was the most prevalent EGD finding (50.1%). Helicobacter pylori was identified in 9.5% of patients who underwent preoperative EGD and in 8.0% of all resected specimens. Less common histopathological findings were metaplasia (0.6%), gastrointestinal stromal tumors (0.3%), gastric polyps (0.2%) and grade 1 gastric carcinoid (0.1%). Among the 357 patients who underwent preoperative EGD, sensitivity was 99.5%, specificity 98.3%, positive predictive value 98.4%, negative predictive value 99.4% and accuracy 98.9% against resected-specimen histopathology. Gastritis is the most prevalent histopathological finding in resected specimens following sleeve gastrectomy and on preoperative EGD, although significant pathologies are infrequent. In the selected subgroup of patients who underwent preoperative EGD, a normal EGD showed high agreement with normal histopathology of the resected specimen; these findings do not support omitting histopathological examination of resected specimens, and prospective multicenter studies are needed. Helicobacter pylori was frequently identified and was strongly associated with gastritis in unadjusted analyses; premalignant findings were too few to assess.