Gastric Pouch Adenocarcinoma and Tubular Adenoma of the Pylorus: A Field Effect of Dysplasia following Bariatric Surgery
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There are reports of gastric carcinoma following bariatric surgery, but it is unclear if these procedures predispose to malignancy.We present a case of a 60-year-old man who, 15 years after vertical banded gastroplasty (VBG), had a massive upper GI bleed. Endoscopy revealed a large tumor of the gastric pouch. Histology confirmed an intestinal type of gastric adenocarcinoma arising in a background of H. pylori-negative gastritis with atrophy, foveolar hyperplasia and intestinal metaplasia. An incidental tubular adenoma at the pylorus was also identified. The pathogenesis of gastric pouch carcinoma is discussed. The present example of neoplastic change in both the pouch and pylorus may indicate that a field effect for dysplasia develops subsequent to VBG.
- Allen JW, Leeman MF, Richardson JD. Esophageal carcinoma following bariatric procedures. JSLS 2004; 8: 372–5.
- Snook KL, Ritchie JD. Carcinoma of esophagus after adjustable gastric banding. Obes Surg 2003; 13: 800–2. CrossRef
- Zirak C, Lemaitre J, Lebrun E et al. Adenocarcinoma of the pouch after silastic ring vertical gastroplasty. Review. Obes Surg 2002; 12: 693–4. CrossRef
- Papakonstantinou A, Moustafellos P, Terzis I et al. Gastric cancer occurring after vertical banded gastroplasty. Obes Surg 2002; 12: 118–20. CrossRef
- Safatle-Ribeiro AV, Ribeiro U Jr, Reynolds JC et al. Morphologic, histologic and molecular similarities between adenocarcinomas arising in the gastric stump and intact stomach. Cancer 1996; 78: 2288–99. CrossRef
- MacDonald WC, Owen DA. Gastric carcinoma after surgical treatment of peptic ulcer: an analysis of morphologic features and a comparison with cancer in the non-operated stomach. Cancer 2001; 91: 1732–8. CrossRef
- Toftgaard C. Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg 1989; 210: 159–64. CrossRef
- Safatle-Ribeiro AV, Ribeiro U Jr, Reynolds JC. Gastric stump cancer: what is the risk? Dig Dis 1998; 16: 159–68. CrossRef
- Offerhaus GJ, van de Stadt J, Huibregtse K et al. The mucosa of the gastric remnant harboring malignancy. Histologic findings in the biopsy specimens of 504 asymptomatic patients 15 to 46 years after partial gastrectomy with emphasis on non-malignant lesions. Cancer 1989; 64: 698–703. CrossRef
- Stael von Holstein C, Hammar E, Eriksson S et al. Clinical significance of dysplasia in gastric remnant biopsy specimens. Cancer 1993; 72: 1532–5. CrossRef
- Negri M, Bendet N, Halevy A et al. Gastric mucosal changes following gastroplasty: A comparative study between vertical banded gastroplasty and silastic ring vertical gastroplasty. Obes Surg 1995; 5: 383–6. CrossRef
- Correa P. Diet modification and gastric cancer prevention. J Natl Cancer Inst Monogr 1992; 12: 75–8.
- Sipponen P, Kekki M, Haapakoski J et al. Gastric cancer risk in chronic atrophic gastritis: statistical conclusions of cross-sectional data. Int J Cancer 1985; 35: 173–7. CrossRef
- De Roover A, Detry O, Desaive C et al. Risk of upper gastrointestinal cancer after bariatric operations. Obes Surg 2006; 16: 1656–61. CrossRef
- Hackert Th, Dietz M, Tjaden C et al. Band erosion after gastric cancer. Obes Surg 2004; 14: 559–61. CrossRef
- Sweet WA. Linitis plastica presenting as pouch outlet stenosis 13 years after vertical banded gastroplasty. Obes Surg 1996; 6: 66–70. CrossRef
- Ovrebo KK, Hatlebakk JG, Viste A et al. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty. Ann Surg 1998; 228: 51–8. CrossRef
- Ishaq S, Jankowski JA. Barrett’s metaplasia: clinical implications. World J Gastroenterol 2001; 7: 563–5.
- Nilsson M, Johnsen R, Ye W et al. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 2003; 290: 66–72. CrossRef
- Nilsson M, Lagergren J. The relation between body mass and gastro-oesophageal reflux. Best Pract Res Clin Gastroenterol 2004; 18: 1117–23.
- Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 1999; 130: 883–90.
- Forman D, Newell DG, Fullerton F et al: Association between infection with Helicobacter pylori and risk of gastric cancer: Evidence from a prospective investigation. BMJ 1991; 302: 1302–5. CrossRef
- Nomura A, Stemmermann GN, Chyou PH et al. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med 1991; 325: 1132–6. CrossRef
- Parsonnet J, Friedman GD, Vandersteen DP et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 1991; 325: 1127–31. CrossRef
- Kikugawa K, Kato T, Takeda Y. Formation of a highly mutagenic diazo compound from the bamethannitrite reaction. Mutat Res 1987; 177: 35–43.
- Mirvish SS, Grandjean AC, Moller H et al. NNitrosoproline excretion by rural Nebraskans drinking water of varied nitrate content. Cancer Epidemiol Biomarkers Prev 1992; 1: 455–61.
- Gastric Pouch Adenocarcinoma and Tubular Adenoma of the Pylorus: A Field Effect of Dysplasia following Bariatric Surgery
Volume 17, Issue 6 , pp 843-846
- Cover Date
- Print ISSN
- Online ISSN
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- Morbid obesity
- bariatric surgery
- vertical banded gastroplasty
- gastric pouch adenocarcinoma
- Industry Sectors
- Author Affiliations
- 1. Department of Laboratory Medicine, Peter Lougheed Centre, 3500-26th Street NE, Calgary, AB T1Y 4J6, Canada
- 3. Department of Gastroenterology, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
- 2. Department of General Surgery, Peter Lougheed Centre, Calgary, AB, Canada