Histopathological Examination of 404 Sleeve Gastrectomy Specimens at a Large UK Center and Systematic Review of the Published Literature.

Background: Laparoscopic sleeve gastrectomy (LSG) specimens are histologically analyzed to identify incidental pathologies. However, no guidelines recommend routine histology. This study evaluates the clinical utility of LSG sample analysis and if incidental diagnoses have a significant clinical impact.

Methods: A single high-volume UK bariatric unit retrospectively gathered LSG data covering a 9-year period. All specimens were sent for histological analysis. Where incidental diagnoses were identified, patient records were reviewed to assess any clinical management alterations. A systematic review (2013-2023) was performed, exploring rates of incidental pathologies post-LSG. Publications were stratified into those performing routine pre-operative endoscopy, or not, and results compared to present data.

Results: From 01/06/2013 to 12/12/2022, 404 patients underwent LSG. 365/404 (90.4%) had no pathology on histopathological analysis. Seven (1.7%) appeared macroscopically abnormal, with histology identifying 3 polyposis and 1 each of GIST, pernicious anaemia, sarcoidosis and gastritis. Ten (2.48%) appeared macroscopically normal but had incidental pathology. All patient management remained unchanged. Twenty-two (5.44%) were H. pylori positive. Forty-eight publications within wider literature reviewed LSG specimen histology. Fifteen, including 9662 patients undergoing pre-operative endoscopy, found pathological diagnoses in 0.5% and 1 malignancy. Thirty-three studies reporting 17,008 patients without pre-operative endoscopy identified pathologies in 0.45% and 7 malignancies.

Conclusion: There is little clinical utility in analyzing macroscopically normal gastric samples following LSG. The potential financial and environmental savings from limiting this practice are of great importance to worldwide bariatric teams. The authors recommend selectively sending LSG specimens only if abnormal gastric mucosa is identified when examining the extracted specimen.