Gastric cancer after laparoscopic adjustable gastric banding: case report

Laparoscopic Adjustable Gastric Banding: an Underestimated Risk Factor for the Development of Esophageal Cancer?-a Nationwide Survey

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.

Esophageal Squamous Cell Carcinoma After Adjustable Gastric Banding

The prevalence of morbid obesity has been increasing worldwide. Therefore, multiple laparoscopic adjustable gastric bandings (LAGBs) have been placed in Belgium in the nineties. The procedure was considered as minimal invasive with low morbidity rates. However, some publication cases suggest a possible association between LAGB and the onset of an esophageal cancer. We present a case of a 49-year-old female who consulted for dysphagia, epigastric pain, and anorexia 17 years after LAGB. An esophageal squamous cell carcinoma was diagnosed in the distal esophagus, close to the lap band. The diagnostic value of the performed contrast swallow study seemed limited. We suggest that a routinely gastroscopic evaluation in the long-term follow-up after LAGB should be strived for in patients presenting with late-onset dysphagia.