Histopathological Findings in Sleeve Gastrectomy Specimens: Prevalence, Determinants, and Clinical Implications in a Large Brazilian Cohort

BACKGROUND: The clinical relevance of routine histopathological examination of sleeve gastrectomy specimens remains controversial. OBJECTIVE: To evaluate the prevalence of histopathological findings, their association with Helicobacter pylori, and potential implications for clinical management. METHODS: Retrospective cross-sectional study including 1,475 patients undergoing sleeve gastrectomy (2014-2024) at a tertiary referral center in Brazil. Histopathological findings were classified according to the Updated Sydney System. Associations were analyzed using Poisson regression variance. RESULTS: Inflammatory changes were observed in 55.1% of specimens, predominantly mild gastritis (73.2%). H. pylori was detected in 7.3%. Premalignant lesions were rare: atrophic gastritis (0.3%), intestinal metaplasia (0.6%), and one adenocarcinoma (0.07%). H. pylori was independently associated with gastritis (adjusted PR ranging from approximately 15 to 18, p < 0.001) and severity (p < 0.001). No association was observed with age or sex. Intestinal metaplasia was associated with age (p = 0.024). CONCLUSIONS: Histopathological abnormalities are common but predominantly mild. Clinically significant lesions are rare. Routine histopathological evaluation may detect unexpected findings in selected cases, but its universal role in risk stratification remains unclear.