H. pylori (HP) is the most prevalent chronic bacterial infection worldwide. HP has not been associated with adverse outcomes following sleeve gastrectomy (SG), nonetheless, it is recommended practice to eradicate HP if infection is diagnosed. It is unclear if there is a true clinical need to screen for HP and then eradicate it in patients undergoing SG.
This study aims to assess the rate of HP positivity in an Australian cohort of patients undergoing SG. Secondary outcomes include the diagnostic yield of preoperative endoscopy and the association of HP infection to postoperative complications.
A retrospective review was performed of a prospectively maintained database including all adult patients who underwent SG and preoperative endoscopy from July 2014 to March 2020 by five surgeons in public and private settings in Victoria. Patients who did not have preoperative endoscopy with biopsy, or did not have their specimen sent for histopathology, were excluded from this study.
Of 592 patients who had SG, 294 met inclusion criteria. HP positivity rate on preoperative endoscopy was 16.7% (n=49/294) and 6.1% (n=18/294) in operative specimens. HP was found in 1.6% of postoperative specimens despite a negative preoperative biopsy and in 27.9% of those who had had eradication treatment.
Presence of HP on preoperative endoscopy was strongly associated with HP in the specimen (OR 24.1, 7.507-77.370, p<0.001). HP in the specimen was not significantly associated with postoperative morbidity (OR 0.988, 0.217-4.502, p=0.672).
The prevalence of preoperative HP infection was 16.7 %. First line HP eradication was effective in 72.0% of this group. HP was diagnosed postoperatively in 1.6% after a negative preoperative biopsy. HP was not linked to an increased rate of postoperative complications.