Pathologists Should Review Bariatric Surgery Specimens

Lara C. Pullen, PhD

September 11, 2014

CHICAGO — Most patients undergoing bariatric surgery have unexpected findings in their gastric sleeve specimens that necessitate treatment, report researchers who found clinically significant histologic findings, including chronic gastritis, gastrointestinal stromal tumor, and adenocarcinoma.

"These surgeries are considered pretty routine," lead investigator Rachel Gordezky, MD, from the University of Illinois at Chicago, told Medscape Medical News, "but even in these routine cases, we found pathologies that required treatment," she said. "What first spurred the project is when we found gastrointestinal stromal tumor. We wondered how many times this has happened."

Dr. Gordezky presented her research during a poster session here at the College of American Pathologists (CAP) 2014. She studied the specimens from 343 bariatric gastric sleeve surgery cases performed at her institute from January 2009 to August 2013. This large retrospective case review is the first to examine the histopathology of sleeve gastrectomy samples.

Pathologists at the University of Illinois at Chicago routinely examine specimens from bariatric sleeve surgery. But Dr. Gordezky pointed out that many institutions do not routinely do this, and many insurance companies will not pay for an evaluation by a pathologist.

She found that most of the patients had gastritis and 1 of the patients had an unknown recurrence of adenocarcinoma. Of the 6 patients with ulcers, only 2 had a known history.

Table. Findings in Bariatric Sleeve Resections (n = 343)

Pathologic Finding Surgical Cases (%)
Gastritis 69
Gastritis with Heliobacter pylori infection 23
Ulcers 2
Gastrointestinal stromal tumors 0.6
Adenocarcinoma 0.3

 

"Mostly you think of bariatric surgery as just removing normal tissue," Dr. Gordezky said. "You don't really expect to find anything in such a routine specimen."

As the prevalence of obesity increases, so has the incidence of bariatric surgeries.

"The message here is that these specimens should be examined by a pathologist," Philip Cagle, MD, editor-in-chief of Archives of Pathology & Laboratory Medicine, told Medscape Medical News.

Dr. Gordezky and Dr. Cagle have disclsoed no relevant financial relationships.

College of American Pathologists (CAP) 2014. Abstract 84. Presented September 8, 2014.

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