1
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Diab ARF, Oviedo RJ, Nazir S, Sujka JA, DuCoin CG. Foregut Malignancy After Metabolic Surgery: a Literature Review. Obes Surg 2023; 33:623-634. [PMID: 36538212 DOI: 10.1007/s11695-022-06412-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Obesity is known to be epidemiologically associated with malignancy. Although there is an increasing global number of bariatric surgeries, the relationship between bariatric surgery and esophagogastric cancers is not well understood. Diagnosis of esophagogastric cancers following bariatric surgery is challenging because the presentation tends to be nonspecific and may be perceived as usual postoperative symptoms in bariatric patients. Therefore, the early diagnosis requires a high index of suspicion. In addition, endoscopic investigation of the excluded stomach after a Roux-en-Y gastric bypass or a one-anastomosis gastric bypass is technically challenging, which further complicates the diagnosis. The aim of this study is to review the current evidence in the literature on esophagogastric cancers following bariatric surgery.
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Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Rodolfo J Oviedo
- Houston Methodist Department of Surgery, Houston, TX, USA.,Weill Cornell Medical College, New York, NY, USA.,Texas A&M University College of Medicine, Bryan, TX, USA
| | - Sharique Nazir
- Department of Surgery, NYU Grossman School of Medicine, 8714 Fifth Avenue, Brooklyn, NY, 11209, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
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2
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Parmar C, Pouwels S. Oesophageal and Gastric Cancer After Bariatric Surgery: an Up-to-Date Systematic Scoping Review of Literature of 324 Cases. Obes Surg 2022; 32:3854-3862. [PMID: 36241765 DOI: 10.1007/s11695-022-06304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This review aimed to give an updated overview of the occurrence, diagnosis, treatment and outcome of oesophageal and gastric cancer after bariatric and metabolic surgery (BMS). METHODS Two searches were done (one for original studies and one for systematic reviews) using an adapted form of "scoping review methodology". MEDLINE, Embase, CINAHL, Pubmed and the Cochrane Library were searched for studies on patients with either oesophageal or gastric cancer after BMS. RESULTS A total of 52 unique studies were included which reported on 324 patients, which included 110 (34%) males and 136 (42%) females. In the remaining 78 patients, gender was not specified. A mean of 62.95 ± 32.75 months was the time from BMS to diagnosis of cancer. Most of the patients had a Roux-en-Y gastric bypass (RYGB) as index bariatric surgical procedure, followed by gastric banding (GB) and sleeve gastrectomy (SG) (respectively, 133 (41.0%) RYGB, 97 (30.0%) GB and 58 (18.0%) SG). Seven cases have been reported after OAGB-MGB (3 in gastric remnant, 4 in oesophagus/gastric pouch). Seventy-seven (24%) had distant metastasis (≥ M1/Mx status). The majority of tumours were adenocarcinoma (n = 208, 87.4%). In the majority of the cases, a surgical approach was preferred with either adjuvant chemo or radiotherapy. In the course of the disease, 122 of 324 patients died (37.8%). CONCLUSION To our knowledge, this is the most up-to-date review addressing oesophageal and gastric malignancies after bariatric surgery. Future research should focus to optimise screening for oesophageal and gastric cancer after bariatric surgery.
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Affiliation(s)
- Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, UK.
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
- Department of Surgery, Agaplesion Bethanien Hospital, Frankfurt am Main, Hessen, Germany
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3
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Chemaly R, Diab S, Khazen G, Al-Hajj G. Gastroesophageal Cancer After Gastric Bypass Surgeries: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:1300-1311. [PMID: 35084611 DOI: 10.1007/s11695-022-05921-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/11/2022]
Abstract
Data comparing the occurrence of gastroesophageal cancer after gastric bypass procedures are lacking and are only available in the form of case reports. We perform in this study a systematic review and a meta-analysis of all the reported cases of gastroesophageal cancer following Roux-en-Y gastric bypass (RYGB) and loop gastric bypass-one anastomosis gastric bypass/mini gastric bypass (LGB-OAGB/MGB). We conducted a systematic review of all the reported cases in articles referenced in PubMed/Medline, Cochrane, and Scholar Google. Only cases of gastro-esophageal adenocarcinoma following RYGB or LGB-OAGB/MGB are included. Statistical analysis was done accordingly. Fifty cases were identified, along with 2 reported in this paper. Sixty-one percent (27/44) of the cancers after RYGB were in the gastric tube compared to 37.5% (3/8) after LGB-OAGB/MGB. This resulted in an odds ratio of 0.38 (p-value = 0.26), which failed to prove an increase in cancer occurrence in the gastric tube after LGB-MGB/OAGB compared to RYGB. The most common symptoms were dysphagia for cancers occurring in the gastric tube (15/30) and abdominal pain for those occurring in the excluded stomach (10/22). Twenty-nine/thirty of the cancers in the gastric tube were diagnosed by gastroscopy and 13/22 of the cancers in the excluded stomach were diagnosed by CT scan. Gastroesophageal cancers after gastric bypass procedures occur commonly in the excluded stomach where many are not identified by conventional means. Physician awareness and patient education as well as lifelong follow-up are essential for maintaining bypass surgeries on the beneficial side.
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Affiliation(s)
- Rodrigue Chemaly
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon. .,Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon.
| | - Samer Diab
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Georges Khazen
- Department of Computer Science and Mathematical, Lebanese American University, Beirut, Lebanon
| | - Georges Al-Hajj
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon.,Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon
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4
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Bevilacqua LA, Obeid NR, Yang J, Zhu C, Altieri MS, Spaniolas K, Pryor AD. Incidence of GERD, esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma after bariatric surgery. Surg Obes Relat Dis 2020; 16:1828-1836. [DOI: 10.1016/j.soard.2020.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
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5
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Ooi GJ, Browning A, Hii MW, Read M. Perioperative screening, management, and surveillance of Barrett's esophagus in bariatric surgical patients. Ann N Y Acad Sci 2020; 1481:224-235. [PMID: 32794237 DOI: 10.1111/nyas.14441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
Obesity is a strong risk factor for Barrett's esophagus (BE), the only proven precursor lesion to esophageal adenocarcinoma (EAC). Bariatric surgery is currently the only reliable treatment that achieves long-term sustained weight loss; however, it can markedly affect the development of de novo BE, and the progression or regression of existing BE. Bariatric procedures may also have implications on future surgical management of any consequent EAC. In this review, we examine the current evidence and published guidelines for BE in bariatric surgery. Current screening practices before bariatric surgery vary substantially, with conflicting recommendations from bariatric societies. If diagnosed, the presence of BE may alter the type of bariatric procedure. A selective screening approach prevents unnecessary endoscopy; however, there is poor symptom correlation with disease. Studies suggest that sleeve gastrectomy predisposes patients to gastroesophageal reflux and de novo BE. Conversely, Roux-en-Y gastric bypass is associated with decreased reflux and potential improvement or resolution of BE. There are currently no guidelines addressing the surveillance for BE following bariatric surgery. BE is an important consideration in the management of bariatric surgical patients. Evidence-based recommendations are required to guide procedure selection and postoperative surveillance.
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Affiliation(s)
- Geraldine J Ooi
- Department of Surgery, Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Alison Browning
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michael W Hii
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.,Department of Surgery, the University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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6
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Jaruvongvanich V, Matar R, Ravi K, Murad MH, Vantanasiri K, Wongjarupong N, Ungprasert P, Vargas EJ, Maselli DB, Prokop LJ, Abu Dayyeh BK. Esophageal Pathophysiologic Changes and Adenocarcinoma After Bariatric Surgery: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2020; 11:e00225. [PMID: 32955206 PMCID: PMC7447443 DOI: 10.14309/ctg.0000000000000225] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To assess the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on acid reflux and esophageal motor function and to evaluate the observation of esophageal adenocarcinoma (EAC) after bariatric surgery. METHODS We searched 5 databases for adults who underwent SG or RYGB and had esophageal pH test and/or esophageal manometry before and after surgery. A separate systemic search of observational studies and a retrospective review at 3 institutions of adults who developed EAC after these surgeries were conducted. Outcomes were changes in manometric and pH parameters and EAC cases after SG and RYGB. RESULTS A total of 27 nonrandomized studies (SG: 612 patients; RYGB: 470 patients) were included. After SG, lower esophageal sphincter pressure and esophageal body amplitude were decreased and the risk of ineffective esophageal motility was increased. Total and recumbent acid exposure times were increased. After RYGB, an increased risk of ineffective esophageal motility was observed. Total, upright, and recumbent acid exposure times were decreased. The total reflux episodes remained unchanged but with increased nonacid reflux and decreased acid reflux events. Including our largest series, 31 EAC cases have been reported to date after SG and RYGB. DISCUSSION This systematic review demonstrates increased acid reflux after SG and decreased acid reflux after RYGB. An observed increased nonacid reflux after RYGB might contribute to failure of gastroesophageal reflux disease improvement. This refluxate might be noxious to the esophagus, warranting further studies. RYGB might not entirely preserve esophageal function as previously believed.
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Affiliation(s)
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - M. Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kornpong Vantanasiri
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Nicha Wongjarupong
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Patompong Ungprasert
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA;
| | - Eric J. Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B. Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J. Prokop
- Division of Library Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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7
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ASMBS position statement on the relationship between obesity and cancer, and the role of bariatric surgery: risk, timing of treatment, effects on disease biology, and qualification for surgery. Surg Obes Relat Dis 2020; 16:713-724. [DOI: 10.1016/j.soard.2020.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022]
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8
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Ebrahimi R, Kermansaravi M, Khalaj A, Eghbali F, Mousavi A, Pazouki A. Gastro-Intestinal Tract Cancers Following Bariatric Surgery: a Narrative Review. Obes Surg 2020; 29:2678-2694. [PMID: 31175561 DOI: 10.1007/s11695-019-04007-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery's effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. The aim of this study is to compile available data about gastro-intestinal (GI) cancers, occurring after different bariatric surgeries. Although GI cancers are considered a rare complication of obesity surgery, they do exist, and diagnosis needs a high index of suspicion.
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Affiliation(s)
- Reza Ebrahimi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran.
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Foolad Eghbali
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran
| | - Ali Mousavi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran
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9
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Gehwolf P, Kienzl-Wagner K, Cakar-Beck F, Schäfer A, Wykypiel H. Laparoscopic Adjustable Gastric Banding: an Underestimated Risk Factor for the Development of Esophageal Cancer?-a Nationwide Survey. Obes Surg 2019; 29:626-631. [PMID: 30402803 DOI: 10.1007/s11695-018-3576-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately 14% of Austria's 8.5 million inhabitants have a body mass index (BMI) > 30 kg/m2. The laparoscopic adjustable gastric banding (LAGB) was introduced in Austria in 1994, where about 10.300 patients have received it so far. One of our LAGB patients developed an adenocarcinoma of the distal esophagus 13 years after implantation. OBJECTIVES In order to calculate whether after LAGB patients are at higher risk for carcinoma of the esophagus, we performed a nationwide survey. METHODS A questionnaire was sent to all surgical departments in Austria, primarily in order to detect cases with esophageal carcinoma after LAGB, but also to evaluate the policy in Austria concerning preoperative work-up, operation, and follow-up in LAGB patients. RESULTS Since 1994, 37 of the 119 surgical departments in Austria have performed a total of about 10.300 LAGB implantations. Six patients have been identified with esophageal cancer following LAGB. The WHO statistical report on esophageal cancer shows an incidence of 2.8/100.000 per year in Austria, about 1/3 of which cases are adenocarcinoma of the distal esophagus. CONCLUSION Following LAGB, the incidence of esophageal cancer might be up to fivefold higher than the aged standardized overall population of Austria.
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Affiliation(s)
- Philipp Gehwolf
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Katrin Kienzl-Wagner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Fergül Cakar-Beck
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Aline Schäfer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Heinz Wykypiel
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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10
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Abstract
A variety of esophageal diseases are treated with esophagectomy, from benign to esophageal cancer. Careful attention must be given to management of the difficult conduit, including patients who have had prior gastric surgery and other procedures, patients with conditions such as diabetic gastroparesis, which can affect the stomach as a future usable conduit, and patients who have an absent or unusable stomach. In these situations, consideration should be raised for the use of alternative conduits, including jejunal and colonic interposition conduits. The esophageal surgeon should also be adept at management of intraoperative difficulties with the conduit.
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Affiliation(s)
- Rajat Kumar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama Birmingham Medical Center, Birmingham, AL, USA
| | - Benjamin Wei
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama Birmingham Medical Center, Birmingham, AL, USA.
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11
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Yousuf H, Saleem HMK, Maan MAA, Chaudhary NA. Atypical Presentation of Gastric Cancer Approached Via Retrograde Single Balloon Enteroscopy. Cureus 2018; 10:e3249. [PMID: 30416900 PMCID: PMC6217871 DOI: 10.7759/cureus.3249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The paradigm for the diagnosis and management of gastric cancer is changing with advanced diagnostic and therapeutic interventions. Prior gastric surgery (20 years or more) is one of the risk factors for gastric cancer. Increased intragastric carcinogen formation is thought to contribute toward gastric cancer development in the remaining portion of the stomach. This case illustrates the importance of a thorough clinical and pathologic workup and highlights the advanced technique of single-balloon enteroscopy (SBE) and its role in managing patient’s health.
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Affiliation(s)
- Hina Yousuf
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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12
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Braghetto I, Martinez G, Korn O, Zamorano M, Lanzarini E, Narbona E. Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study). Surg Today 2018; 48:558-565. [PMID: 29450656 DOI: 10.1007/s00595-018-1625-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/05/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) without resection of the distal stomach is largely performed over the world for morbid obesity. Potential risk of gastric remnant carcinoma development has been suggested. PURPOSE To present the results obtained after LRYGB with resection of distal stomach. METHOD This prospective study includes 400 consecutive patients. The mean body weight was 105.9 ± 16.8 Kg (range 83-145 kg), and body mass index (BMI) was 38.5 ± 4.4 kg/m2 (32.9-50.3). Postoperative morbid-mortality and follow-up were analyzed. RESULTS Operative time was 128.5 ± 18.7 min, hospital discharge occurred at 3rd postoperative day, postoperative complications occurred in 9.25%, early surgical complications were observed in 3% and medical complications 4%, late surgical complications occurred 2.25%, no mortality was observed. At 1 year follow-up, BMI was 25.3 ± 2.7 kg/m2 with % of weight loss (%WL) of 84.6 + 19.1%. At five years follow-up very similar values were observed. CONCLUSION The results obtained after LRYGB with resection of distal stomach are similar to results published after non resection LRYGB regarding early and late results and can be indicated in high risk areas of gastric carcinoma.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile.
| | - Gustavo Martinez
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Owen Korn
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Marcelo Zamorano
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Enrique Narbona
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
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13
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Jain DH, Vlahu TS, Kemmeter PR, Onesti JK. Laparoscopic transhiatal esophagectomy after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2017; 14:123-124. [PMID: 29287753 DOI: 10.1016/j.soard.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Deepali H Jain
- Grand Rapids Medical Education Partners, Department of Surgery, Grand Rapids, Michigan; Michigan State University, College of Human Medicine, Grand Rapids, Michigan.
| | - Tedi S Vlahu
- Grand Rapids Medical Education Partners, Department of Surgery, Grand Rapids, Michigan; Michigan State University, College of Human Medicine, Grand Rapids, Michigan
| | - Paul R Kemmeter
- Grand Rapids Medical Education Partners, Department of Surgery, Grand Rapids, Michigan; Michigan State University, College of Human Medicine, Grand Rapids, Michigan; Grand Health Partners, Grand Rapids, Michigan
| | - Jill K Onesti
- Grand Rapids Medical Education Partners, Department of Surgery, Grand Rapids, Michigan; Michigan State University, College of Human Medicine, Grand Rapids, Michigan; Mercy Health Saint Mary's, Grand Rapids, Michigan
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14
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Abstract
Obesity is now epidemic worldwide, and an increasing number of patients have undergone a weight-loss procedure. Although obesity is a risk factor for esophageal cancer, there are few reports on esophagectomy after bariatric procedures. Careful understanding of the patient's gastroesophageal anatomy as a result of the bariatric procedure and attention to the creation of the esophageal replacement conduit are fundamental for the success of esophagectomy after bariatric surgery.
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Affiliation(s)
- Katy A Marino
- Division of Thoracic Surgery, University of Tennessee Health Science Center, 1325 Eastmoreland Avenue, Suite #460, Memphis, TN 38104, USA
| | - Benny Weksler
- Division of Thoracic Surgery, University of Tennessee Health Science Center, 1325 Eastmoreland Avenue, Suite #460, Memphis, TN 38104, USA.
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15
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Pastorello RG, de Macedo MP, da Costa Junior WL, Begnami MDFS. Gastric Pouch Mixed Adenoneuroendocrine Carcinoma With a Mixed Adenocarcinoma Component After Roux-en-Y Gastric Bypass. J Investig Med High Impact Case Rep 2017; 5:2324709617740908. [PMID: 29164159 PMCID: PMC5686881 DOI: 10.1177/2324709617740908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/25/2017] [Accepted: 10/10/2017] [Indexed: 01/14/2023] Open
Abstract
The Roux-en-Y gastric bypass is one of the most common procedures currently performed for surgical treatment of patients with severe obesity. Gastric cancer after bariatric surgery is not common, with most of them arising in the excluded stomach. Gastric mixed adenoneuroendocrine carcinomas are a rare type of stomach malignancy, composed of both adenocarcinoma and neuroendocrine tumor-cell components, with the latter comprising at least 30% of the whole neoplasm. In this article, we report a unique case of a mixed adenoneuroendocrine carcinoma with a mixed adenocarcinoma (tubular and poorly cohesive) component arising in the gastric pouch of a patient who underwent previous Roux-en-Y gastric bypass for glycemic control. Since stomach cancer is not usual in patients who have formerly undergone bariatric surgery and symptoms tend to be nonspecific, such diagnosis is often rendered at an advanced stage. Full assessment of these patients when presenting such vague symptoms is critical for an early cancer diagnosis.
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16
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Adenocarcinoma of the gastric pouch after Roux-en-Y gastric bypass: a new technique for en bloc resection and reconstruction. Surg Obes Relat Dis 2017; 13:1793-1795. [PMID: 28780047 DOI: 10.1016/j.soard.2017.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/04/2017] [Accepted: 07/07/2017] [Indexed: 11/20/2022]
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17
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Ahmad W, Rubin J, Kwong W. Percutaneous endoscopy to diagnose malignancy in gastric outlet obstruction of excluded stomach after gastric bypass. Ann Gastroenterol 2017; 30:367-369. [PMID: 28469371 PMCID: PMC5411391 DOI: 10.20524/aog.2017.0132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/06/2017] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer in the excluded stomach after Roux-en-Y gastric bypass is a rare finding and most reported diagnoses are made via surgery. Endoscopic access to the excluded stomach is difficult, even with balloon-assisted enteroscopy. We present the case of a 74-year-old woman with malignant gastric outlet obstruction of the excluded stomach, 41 years after Roux-en-Y gastric bypass. Minimally invasive access to the excluded stomach was obtained by placement of a percutaneous gastrostomy tube, followed by insertion of a pediatric gastroscope through the gastrostomy tube tract. This novel approach provides minimally invasive access to the excluded stomach in patients with high suspicion of pathology in the excluded stomach, when balloon-assisted enteroscopy is not technically feasible or available.
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Affiliation(s)
- Waseem Ahmad
- Department of Medicine (Waseem Ahmad, Joshua Rubin, Wilson Kwong)
| | - Joshua Rubin
- Department of Medicine (Waseem Ahmad, Joshua Rubin, Wilson Kwong).,Division of Gastroenterology (Joshua Rubin, Wilson Kwong), University of California San Diego, La Jolla, California, USA
| | - Wilson Kwong
- Department of Medicine (Waseem Ahmad, Joshua Rubin, Wilson Kwong).,Division of Gastroenterology (Joshua Rubin, Wilson Kwong), University of California San Diego, La Jolla, California, USA
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Gorodner V, Buxhoeveden R, Clemente G, Sánchez C, Caro L, Grigaites A. Barrett's esophagus after Roux-en-Y gastric bypass: does regression occur? Surg Endosc 2016; 31:1849-1854. [PMID: 27553805 DOI: 10.1007/s00464-016-5184-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Barrett's esophagus (BE) is recognized as a premalignant lesion for esophageal adenocarcinoma. BE appears as a consequence of gastroesophageal reflux disease (GERD), which is increased among obese population. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the best treatment option for obesity combined with GERD. However, data on evolution of BE after LRYGB are scarce. METHODS AND PROCEDURES Patients were studied with esophagogastroduodenoscopy (EGD) and gastric biopsy preoperatively. If BE was suspected, esophageal biopsy was performed. If BE was confirmed, LRYGB was indicated with yearly surveillance EGD with biopsies. LRYGB patients who had BE with at least 1-year follow-up were included. RESULTS Between 10/07 and 1/16, 2144 patients underwent laparoscopic bariatric surgery at our institution. There were 1681 (78 %) LRYGB, 399 (19 %) laparoscopic sleeve gastrectomies, and 64 (3 %) revisions. Nineteen patients (0.9 %) had BE preoperatively, and they all underwent LRYGB; 11 of them (58 %) were eligible for this study. There were 6 women and 5 men, mean age 49 ± 11 years, initial BMI 44 ± 6 kg/m2. Mean follow-up was 41 ± 31 months; there were 9 short-segment BE (SSBE) and 2 long-segment BE (LSBE). On pre- and post-op EGD, BE length was 2.1 ± 1.6 and 1.2 ± 1.2 cm, respectively (p = NS). Post-op EGD was compatible with BE in all cases, although esophageal biopsy showed remission in 4 (36 %) cases: three short-segment BE (SSBE) and one long-segment BE (LSBE). One patient was indefinite for dysplasia and remained the same after the operation. CONCLUSION Our preliminary data showed that LRYGB is a suitable treatment option for obese patients with BE, demonstrated by 36 % regression rate of this premalignant disease. Although BE persisted in the remaining patients, no progression to dysplasia was observed. A larger number of patients and longer follow-up are needed for more definitive conclusions.
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Affiliation(s)
| | | | | | - Christian Sánchez
- GEDYT Gastroenterología Diagnóstica y Terapéutica, Buenos Aires, Argentina
| | - Luis Caro
- GEDYT Gastroenterología Diagnóstica y Terapéutica, Buenos Aires, Argentina
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19
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Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is widely applied in the treatment of morbid obesity. Health personnel meeting these patients should thus be familiar with the potential clinical consequences of the modified anatomy induced by the surgery. After a RYGB, the stomach is left in situ after the closure of the upper part of the organ. This blind-ended gastric remnant may cause complications and surgical emergencies, but also opportunities for diagnostic and therapeutic intervention. The present review focuses on complications related to the gastric remnant including bleeding and acute dilatation in the early postoperative period and later adverse events such as gastroduodenal peptic disease, tumors, gastrogastric fistulas, and late dilatation. Opportunities offered by the remnant, including minimal invasive or open access for enteral nutrition, and therapeutic and diagnostic access to the bile ducts, the duodenum, and the gastric remnant, which is challenged by the modified anatomy, are discussed. Reversal of the gastric bypass and gastrointestinal reconstruction after esophageal resection have been commented on. The review aims to improve the awareness of issues related to the gastric remnant for physicians involved in the treatment and the follow-up of patients after a RYGB.
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20
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Dantas ACB, Santo MA, de Cleva R, Sallum RAA, Cecconello I. Influence of obesity and bariatric surgery on gastric cancer. Cancer Biol Med 2016; 13:269-76. [PMID: 27458534 PMCID: PMC4944545 DOI: 10.20892/j.issn.2095-3941.2016.0011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.
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Affiliation(s)
| | - Marco Aurelio Santo
- Department of Digestive Surgery, University of São Paulo School of Medicine, São Paulo-SP 05403-000, Brazil
| | - Roberto de Cleva
- Department of Digestive Surgery, University of São Paulo School of Medicine, São Paulo-SP 05403-000, Brazil
| | | | - Ivan Cecconello
- Department of Digestive Surgery, University of São Paulo School of Medicine, São Paulo-SP 05403-000, Brazil
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21
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Ellison HB, Parker DM, Horsley RD, McField D, Friscia ME, Petrick AT. Laparoscopic transhiatal esophagectomy for esophageal adenocarcinoma identified at laparoscopic Roux-en-Y gastric bypass. Int J Surg Case Rep 2016; 25:179-83. [PMID: 27379750 PMCID: PMC4933034 DOI: 10.1016/j.ijscr.2016.05.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 11/18/2022] Open
Abstract
Preoperative endoscopy is indicated bariatric patients with history of gastroesophageal reflux. Laparoscopic transhiatal esophagectomy can be safely performed in patient with history of Roux-en-Y gastric bypass. The gastric remnant provides a good conduit for reconstruction following esophagectomy in patients with a previous Roux-en-Y gastric bypass.
Introduction More than one third of Americans are obese. Obesity is a risk factor for gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma (EA). The only durable treatment for morbid obesity and its comorbid conditions is bariatric surgery. There is no consensus among bariatric surgeons, however, regarding the role of preoperative screening upper endoscopy in bariatric surgery. Presentation of case Two cases of incidental EA were identified by completion EGD following laparoscopic Roux-en-Y gastric bypass (LRYGB). EGD was done for anastomotic surveillance and provocative leak testing. Esophageal masses were identified and biopsies demonstrated adenocarcinoma. In both cases a laparoscopic transhiatal esophagectomy (LTHE) was completed using the gastric remnant as conduit; the biliopancreatic limb was divided proximal to the jejunojejunostomy and anastomosed to the proximal roux limb to complete the reconstruction. Discussion Obesity is a risk factor for GERD and EA. The role of EGD prior to bariatric surgery is unclear. Studies have demonstrated routine EGD prior to bariatric surgery may diagnose foregut pathology; however, few of the findings alter the planned treatment. The cost effectiveness of this strategy is questionable. There are reports of EA developing after bariatric surgery; however, we found no previous case reports of EA identified at LRYGB. Conclusion Our institution has opted for selective preoperative endoscopy in patients with preoperative gastrointestinal symptoms. In post gastric bypass patients LTHE can be performed with good results.
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Affiliation(s)
- Halle B Ellison
- Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States
| | - David M Parker
- Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
| | - Ryan D Horsley
- Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States
| | - Daaron McField
- Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States
| | - Michael E Friscia
- Geisinger Medical Center, Department of Thoracic Surgery, 100 North Academy Ave., Danville PA, 17821, United States
| | - Anthony T Petrick
- Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States
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Sohn S, Fischer J, Booth M. Adenocarcinoma of the gastro-oesophageal junction after sleeve gastrectomy: a case report. ANZ J Surg 2015; 87:E163-E164. [DOI: 10.1111/ans.13064] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sangsu Sohn
- Department of General Surgery; North Shore Hospital; Auckland New Zealand
| | - Jesse Fischer
- Department of General Surgery; North Shore Hospital; Auckland New Zealand
| | - Michael Booth
- Department of General Surgery; North Shore Hospital; Auckland New Zealand
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Kulaylat AN, Sahajwani S, Staveley-O’Carroll KF, Kaifi JT. Reconstructive options for gastroesophageal junction adenocarcinoma after Roux-en-Y gastric bypass. J Thorac Cardiovasc Surg 2013; 146:1296-8. [DOI: 10.1016/j.jtcvs.2013.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/15/2013] [Accepted: 07/09/2013] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Obesity is associated with several comorbidities like diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. It is also well established that obese patients have an increased risk of several types of cancer like kidney, pancreas, endometrial, breast, and others. The bariatric surgeon needs to be aware of the problem of benign tumors and cancer in obese patients as well as the optimal management of these conditions that may be present at the time of evaluation for bariatric surgery, during the surgical procedure, and in the postoperative period. DATABASE A PubMed search for the words "cancer" and "bariatric surgery" and subsequent review of the abstracts identified 40 articles concerning cancerous, benign, and premalignant conditions in bariatric surgery patients. Data were then extracted from full-text articles. CONCLUSION Bariatric surgery decreases cancer risk especially in women. RYGB can be an effective treatment for Barrett's esophagus. Patients having esophageal cancer should not undergo bariatric surgery, while those who develop the same postoperatively are usually managed by a combined abdominal and thoracic approach (Ivor Lewis technique). Gastric cancer of the remnant stomach is usually managed by a remnant gastrectomy. A remnant gastrectomy during RYGB would be necessary in conditions that require endoscopic surveillance of the stomach like gastric polyps, intestinal metaplasia, and carcinoid tumors. Sleeve gastrectomy is an excellent option in a patient with GIST or a carcinoid who needs a bariatric operation. Preoperative endoscopy usually does not detect malignant conditions. Postoperative evaluation of the bypassed stomach is possible using various percutaneous and novel endoscopic techniques.
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Affiliation(s)
- Rao S Raghavendra
- Division of Metabolic Endocrine and Minimally Invasive Surgery, Mount Sinai Medical Center, NY, New York, USA.
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25
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Gastric adenocarcinoma after gastric bypass for morbid obesity: a case report and review of the literature. Case Rep Med 2013; 2013:609727. [PMID: 23509467 PMCID: PMC3590497 DOI: 10.1155/2013/609727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/21/2013] [Indexed: 11/18/2022] Open
Abstract
Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.
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Scozzari G, Trapani R, Toppino M, Morino M. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis 2012; 9:133-42. [PMID: 23265766 DOI: 10.1016/j.soard.2012.10.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 09/06/2012] [Accepted: 10/03/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Because the number of patients with a previous bariatric procedure continues to rise, it is advisable for bariatric surgeons to know how to manage the rare event of the development of an esophagogastric cancer. The aim of the study was to perform a systematic review of all reported cases of esophagogastric cancers after bariatric surgery. METHODS Systematic review of English and French written literature in MEDLINE and EMBASE database. RESULTS Globally, 28 articles describing 33 patients were retrieved. Neoplasms were diagnosed at a mean of 8.5 years after bariatric surgery (range 2 months-29 years). There were 11 esophageal and 22 gastric cancers; although adenocarcinoma represented most cases (90.6%), a tubulovillous adenoma with high-grade atypia, an intramural gastrointestinal stromal tumor, and a diffuse large B-cell lymphoma of the gastric fundus were also reported. Node involvement was reported in 14 cases, and distal metastases in 5. The most frequently reported symptoms were dysphagia and food intolerance, vomiting, epigastric pain, and weight loss. Surgery was performed in 28 patients, although 4 underwent only chemotherapy and/or radiotherapy and 1 received palliative care. Reported mortality rate was 48.1%. CONCLUSIONS To date, it is not possible to quantify the incidence of esophagogastric cancer after bariatric surgery because of the paucity of reported data. Nevertheless, because the main concern is the delay in diagnosis, it is of critical importance to carefully evaluate any new or modified upper digestive tract symptom occurring during bariatric surgery follow-up.
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Stauffer JA, Mathew J, Odell JA. Esophageal adenocarcinoma after laparoscopic gastric band placement for obesity. Dis Esophagus 2011; 24:E8-10. [PMID: 21166738 DOI: 10.1111/j.1442-2050.2010.01154.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Obesity is a risk factor for the development of esophageal malignancy. We report a case of the development of esophageal adenocarcinoma after placement of an adjustable gastric band for obesity. A 66-year-old male was referred to our clinic for findings of an obstructing mass at the gastroesophageal junction after previously undergoing a laparoscopic adjustable gastric band placement. Investigations confirmed a locally advanced poorly differentiated esophageal adenocarcinoma. The patient underwent chemotherapy and gastric band removal with improvement of his dysphagia. However, his disease progressed and he died of metastatic disease. We discuss the diagnosis of esophageal carcinoma after gastric banding procedure.
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Affiliation(s)
- J A Stauffer
- Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA
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28
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Scheepers AF, Schoon EJ, Nienhuijs SW. Esophageal carcinoma after sleeve gastrectomy. Surg Obes Relat Dis 2010; 7:e11-2. [PMID: 21126926 DOI: 10.1016/j.soard.2010.09.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 09/24/2010] [Accepted: 09/24/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Anke F Scheepers
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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