title: Spectrum of Gastric Histopathologies in Severely Obese American Patients Undergoing Sleeve Gastrectomy.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is a commonly performed weight loss procedure, but the pathologic findings in sleeve specimens have not been investigated in a US population.
  
  
  METHODS
  We performed a retrospective review of histopathologic findings in LSG specimens from 310 consecutive bariatric patients at the Hershey Medical Center between June 2008 and August 2014.
  
  
  RESULTS
  Patients were 19 to 75 years old (mean 45 years) with a female-to-male ratio of 3:1. The histopathologic findings included the following: no pathological alteration in 214 patients (69.0 %), chronic inactive gastritis in 41 (13.2 %), fundic gland polyp in 17 (5.5 %), proton pump inhibitor therapy effect in 12 (3.9 %), Helicobacter pylori (H. pylori)-associated chronic active gastritis in 10 (3.2 %), chronic active gastritis (H. pylori negative) in 5 (1.6 %), chronic gastritis with intestinal metaplasia in 4 (1.0 %), gastrointestinal stromal tumor (GIST) in 3 (1.0 %), and hyperplastic polyp, granulomatous inflammation, xanthogranulomatous inflammation, and mucosal ulceration in 1 patient each (0.3 %). Prior endoscopy was performed in 8 patients (2.6 %) for unrelated causes, and the results did not change the surgical management. Nine patients (2.9 %) had a concurrent liver biopsy for visual evidence of significant hepatic fibrosis.
  
  
  CONCLUSIONS
  Although most cases showed no pathologic alteration, a minority had significant findings, with the incidence of GISTs higher than that reported in other series. Despite negative preoperative H. pylori testing, 3.2 % were still histologically positive, raising questions about the accuracy of preoperative methods used for H. pylori testing and treatment. Preoperative endoscopy may not be needed in sleeve patients.
authors.affiliation: Department of Pathology, Division of Anatomic Pathology, College of Medicine, The Pennsylvania State University, 500 University Drive, H179, Hershey, PA, 17033-0850, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Ohanessian
authors.affiliation: Department of Surgery, Division of Minimally Invasive Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rogers
authors.affiliation: Department of Pathology, Division of Anatomic Pathology, College of Medicine, The Pennsylvania State University, 500 University Drive, H179, Hershey, PA, 17033-0850, USA. dkaramchandani@hmc.psu.edu.
authors.forename: Dipti M
authors.initials: DM
authors.lastname: Karamchandani
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013272:Stomach Diseases / Q000150:complications / Q000473:pathology*; D014481:United States; D055815:Young Adult
keywords: Bariatric surgery; Histopathology; Obesity; Sleeve gastrectomy