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How reliable is pre-sleeve endoscopy to characterize pathological features?

Mohammad Heiat1, Mohammad Javanbakht2, Mohammad Ali Abyazi1

  • 1Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.

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Summary

Preoperative endoscopy is highly accurate for detecting H. pylori, atrophy, and metaplasia before sleeve gastrectomy but less reliable for gastritis. This impacts bariatric surgery patient selection and outcomes.

Keywords:
Bariatric surgeryBiopsyGastroesophageal reflux diseaseHelicobacter pyloriHistopathologyPostoperative complicationsSleeve gastrectomy

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Area of Science:

  • Gastroenterology
  • Bariatric Surgery
  • Pathology

Background:

  • Vertical sleeve gastrectomy is a common bariatric procedure with improving safety profiles.
  • The diagnostic accuracy of preoperative endoscopy for histopathological findings before sleeve gastrectomy requires further clarification.
  • Helicobacter pylori (H. pylori) infection and other gastric pathologies can influence surgical outcomes.

Purpose of the Study:

  • To evaluate the negative predictive value of preoperative endoscopic biopsies in detecting H. pylori infection and gastric pathologies.
  • To compare preoperative and postoperative histopathological findings in patients undergoing sleeve gastrectomy.
  • To assess the correlation between preoperative findings and postoperative gastroesophageal reflux disease (GERD) symptoms.

Main Methods:

  • A cross-sectional study involving 102 patients who underwent vertical sleeve gastrectomy.
  • Comparison of preoperative and postoperative esophagogastroduodenoscopy (EGD) specimens for H. pylori, gastritis, atrophy, and metaplasia.
  • Postoperative follow-up of GERD symptoms for six months.

Main Results:

  • Preoperative EGD showed high negative predictive values for H. pylori (95%), atrophy (98%), and metaplasia (93%), but was suboptimal for gastritis (79%).
  • Overall negative predictive value for all pathologies combined was 53.4%.
  • Moderate gastritis and focal metaplasia were significantly underdiagnosed preoperatively. H. pylori and metaplasia were more prevalent in females. H. pylori and gastritis correlated with increased postoperative GERD symptoms.

Conclusions:

  • Preoperative endoscopy is valuable for identifying H. pylori, atrophy, and metaplasia prior to sleeve gastrectomy.
  • Endoscopic assessment for gastritis preoperatively is less reliable and may lead to underdiagnosis.
  • Accurate preoperative diagnosis is crucial for optimizing patient selection and managing potential postoperative complications like GERD.