Abstract
Jejunoileal bypass (JIB) has been a widespread operation for treatment of morbid obesity. Bile acids are regarded as cofactors in the carcinogenesis of the colon, and, since intestinal bypass involves increased exposure of bile acids to the large intestinal mucosa, JIB has been postulated to increase the risk for colorectal carcinoma. In experimental studies on animals, the results have indicated an increased frequency of induced carcinomas, but in clinical series only one patient with colon carcinoma has been reported. Thirty women, operated on with JIB 11 to 17 years earlier, were examined by colonoscopy with multiple biopsies, systematically taken for histologic evaluation and flow cytometric DNA analysis. In only one patient, low-grade dysplasia was detected in an initial adenomatous lesion but was not visible macroscopically. No DNA aneuploidy was found. In a control group of 11 patients examined for non-neoplastic disease, neither dysplasia nor aneuploidy was diagnosed. Within 17 years postoperatively, we have, by these methods, not been able to verify any colorectal malignant transformation in patients operated on with JIB. However, since carcinogenesis is a long process, further surveillance will be demanded before an increased risk for colorectal carcinoma can be excluded.
Similar content being viewed by others
References
Mason EE. Development of gastric bypass and gastroplasty. In: Maxwell JD, Gazet J-C, Pilkinton TR, eds. Surgical management of obesity. London: Academic Press, 1980:29–39.
Hill MJ. Mechanism of colorectal carcinogenesis. In: Joosens J, Hill M, Geboers J, eds. Diet and human carcinogenesis. Amsterdam: Excerpta Medica, 1985:149–64.
Koivisto P, Miettinen TA. Adaptation of cholesterol and bile acid metabolism and vitamin B12 adsorption in the long-term follow-up after partial ileal bypass. Gastroenterology 1986;90:984–90.
Scudamore CH, Freeman HJ. Effects of small bowel transection, resection, or bypass in 1,2-dimethylhydrazine-induced rat intestinal neoplasia. Gastroenterology 1983;84:725–31.
Bristol JB, Wells M, Williamson RC. Adaptation of jejunoileal bypass promotes experimental colorectal carcinogenesis. Br J Surg 1984;71:123–6.
Rainey JB, Davies PW, Williamson RC. Relative effects of ileal resection and bypass on intestinal adaptation and carcinogenesis. Br J Surg 1984;71:197–202.
Silverman SH, Burdon DW, Youngs DJ, Keighley MR, Baddely RM. Fecal flora after jejuno-ileal bypass is bizarre but does not appear to promote colorectal carcinogenesis. Dig Surg 1986;3:100.
MacFarland RJ, Talbot RW, Woolf N, Gazet J-C. Dysplasia of the colon after jejunoileal bypass. Br J Surg 1987;74:21–2.
MacFarland RJ, Gazet J-C, Pilkinton TR. A 13-year review of jejunoileal bypass. Br J Surg 1985;72:81–7.
Riddell RH, Goldman H, Ransohoff DF,et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983;14:931–68.
Rosenstock E, Farmer RG, Petras R, Sivak MV Jr, Rankin GB, Sullivan BH. Surveillance for colonic carcinoma in ulcerative colitis. Gastroenterology 1985;89:1342–6.
Hammarberg C, Slezak P, Tribukait B. Early detection of malignancy in ulcerative colitis: a flow-cytometric study. Cancer 1984;53:291–5.
Löfberg R, Tribukait B, öst å, Boström O, Reichard H. Flow cytometric DNA-analysis in longstanding ulcerative colitis—a method of prediction of dysplasia and cancer development? Gut 1987;28:1100–6.
Rutegård J, åhsgren L, Stenling R, Roos G. DNA content in ulcerative colitis. Flow cytometric analysis in a patient series from a defined catchment area. Dis Colon Rectum 1988;31:710–5.
Payne JH, DeWind LT. Surgical treatment of obesity. Am J Surg 1969;118:141–7.
Sylvan A, Sjölund B, Janunger KG, Carleson R. Jejunoileal bypass: still an alternative? Dig Surg 1986;3:100.
Vindelöv LL, Christensen IJ, Keiding N, Spang-Thomsen M, Nissen N. Long-term storage of samples for flow cytometric DNA analysis. Cytometry 1983;3:317–22.
Vindelöv LL, Christensen IJ, Nissen NJ. A detergent-trypsin method for preparation of nuclei for flow cytometric DNA analysis. Cytometry 1983;3:323–7.
Rider JA, Kirsner JB, Moeller HC, Palmer WL. Polyps of the colon and rectum, their incidence and relationship to carcinoma. Am J Med 1954;16:555–64.
Andrén L, Frieberg S. Frequency of polyps of rectum and colon, according to age and relation to cancer. Gastroenterology 1959;36:631–2.
Ekelund G. On cancer and polyps of colon and rectum. Acta Pathol Microbiol Scand 1963;59:165–70.
Lew EA, Garfinkel L. Variations in mortality by weight among 75,000 men and women. J Chronic Dis 1983;32:563–76.
Author information
Authors and Affiliations
Additional information
This investigation was supported by the Cooperative Health Administrations, Northern Region of Sweden and the Swedish Cancer Society, Project no. 2520-B91-04XBB.
About this article
Cite this article
Sylvan, A., Sjölund, B., Janunger, K.G. et al. Colorectal cancer risk after jejunoileal bypass: Dysplasia and DNA content in longtime follow-up of patients operated on for morbid obesity. Dis Colon Rectum 35, 245–248 (1992). https://doi.org/10.1007/BF02051016
Issue Date:
DOI: https://doi.org/10.1007/BF02051016