Gastric Cancer in the Bypassed Segment After Operation for Morbid Obesity

Abstract

A case is reported in which two separate adenocarcinomas were detected in the bypassed distal stomach 13 years after gastric stapling with loop gastro-enterostomy was performed for the treatment of morbid obesity. Retrograde endoscopy via the afferent loop was used to establish the diagnosis. Although gastritis and metaplasia have been described in the bypassed stomach, only one case of carcinoma in this area has previously been reported.

Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients

“…The most performed bariatric procedure is the RYGBP, which involves the exclusion of a significant part of the stomach. Lesions of the excluded stomach have been reported and the diagnosis of this possibility is difficult, onerous, not always available and, as a result of that, gastric diseases, such as ulcers and malignant neoplasms in the excluded stomach may not be diagnosed (18,21,39) . H. pylori is associated to gastric diseases, such gastritis, ulcer, epithelial atrophy, intestinal metaplasia, lymphoma, adenocarcinoma (9,31) .…”

“…The most frequent bariatric surgery is the Roux-en-Y gastric bypass (RYGBP), which involves partial exclusion of the stomach (3) . Mucosal alterations after vertical banded RYGBP have not been clearly evaluated because the excluded stomach is not easily reached by conventional endoscopy (18,21,39) . Infection by the Helicobacter pylori (H. pylori) causes inflammation of the gastric mucosa, which can develop atrophy, intestinal metaplasia, dysplasia and cancer (3,6,27) .…”

The Contribution of Gastric Emptying Scintigraphy to the Treatment of Obesity With Gastric Bandage - Preliminary Results

“…Carcinoma in a bypassed stomach is not commonly reported in the literature. Nevertheless in case it is found, it is necessary to perform a retrograde entero-gastroscopy 8 and surgical treatment is very diffi cult in these cases [9][10][11] . In patients with existing gastro-esophageal refl ux disease it is wise to use more care when applying the gastric bandage.…”

Report of Two Cases of Gastric Cancer after Bariatric Surgery: Lymphoma of the Bypassed Stomach after Roux-en-Y Gastric Bypass and Gastrointestinal Stromal Tumor (GIST) after Vertical Banded Gastroplasty

“…Four cases of adenocarcinoma of the distal stomach have been reported after gastric bypass. [16][17][18][19] Cancer was diagnosed at an advanced stage in 3 of the cases at 5, 8 and 22 years after the gastric bypass, when symptoms were now secondary to occlusion of the pylorus by the tumor. A fourth patient presented with anemia that was investigated for a year before an endoscopy evaluated the distal stomach through the loop gastroentrostomy and diagnosed two polypoid early gastric cancers.…”