Skip to main content

Advertisement

Log in

Cancer in the bypassed stomach presenting early after gastric bypass

  • Case Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Gastric carcinoma in the bypassed stomach after Roux-en-Y gastric bypass (RYGBP) is rare but has been reported. The time from RYGBP to the presentation of cancer has ranged from 5 to 22 years postoperatively in the literature. A major concern with the current technique for RYGBP is the exclusion of the bypassed stomach and difficulty in surveillance. Thus, some surgeons recommend routine preoperative evaluation via endoscopy. Although most findings are benign, abnormalities are frequently discovered during screening endoscopy in bariatric surgery patients. We present a 45-year-old woman who was discovered to have disseminated gastric cancer involving the excluded bypassed stomach following an open RYGBP. Preoperative upper endoscopy was not performed. This case illustrates the importance of endoscopic evaluation prior to RYGBP and signifies the need for a high index of suspicion in order to recognize this problem at an early stage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991; 1: 257–65.

    Article  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E et al. Bariatric Surgery. A systematic review and meta-analysis. JAMA 2004; 292: 1724–37.

    Article  PubMed  CAS  Google Scholar 

  3. Maggard MA, Shugarman LR, Suttorp M et al. Meta-analysis: Surgical treatment of obesity. Ann Intern Med 2005; 142: 547–59.

    PubMed  Google Scholar 

  4. Sjostrom L, Lindroos AK, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93.

    Article  PubMed  Google Scholar 

  5. Buchwald H, Williams SE. Bariatric surgery world-wide 2003. Obes Surg 2004; 14: 1157–64.

    Article  PubMed  Google Scholar 

  6. Sundbom M, Nyman R, Hedenström H et al. Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg 2001; 11: 25–7.

    Article  PubMed  CAS  Google Scholar 

  7. Madan AK, Speck KE, Hiler ML. Routine preoperative upper endoscopy for laparoscopic gastric bypass: Is it necessary? Am Surg 2004; 70: 684–6.

    PubMed  Google Scholar 

  8. Raijman I, Strother SV, Donegan WL. Gastric cancer after gastric bypass for obesity. Case report. J Clin Gastroenterol 1991; 13: 191–4.

    Article  PubMed  CAS  Google Scholar 

  9. Escalona A, Guzmán S, Ibáñez L et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg 2005; 15: 423–7.

    Article  PubMed  Google Scholar 

  10. Lord RV, Edwards PD, Coleman MJ. Gastric cancer in the bypassed segment after operation for morbid obesity. Aust NZ J Surg 1997; 67: 580–2.

    Article  CAS  Google Scholar 

  11. Khitin L, Roses R, Birkett D. Cancer in the gastric remnant after gastric bypass. Curr Surg 2003; 60: 521–3.

    Article  PubMed  Google Scholar 

  12. Zeni TM, Frantzides CT, Mahr C et al. Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass. Obes Surg 2006; 16: 142–6.

    Article  PubMed  Google Scholar 

  13. Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 2002; 12: 634–8.

    Article  PubMed  Google Scholar 

  14. Sharaf RN, Weinshel EH, Bini EJ et al. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg 2004; 14: 1367–72.

    Article  PubMed  Google Scholar 

  15. Barmeir EP, Solomon H, Charuzi I et al. Radiologic assessment of the distal stomach and duodenum after gastric bypass: percutaneous CT-guided transcatheter technique. Gastrointest Radiol 1984; 9: 203–5.

    Article  PubMed  CAS  Google Scholar 

  16. Rankin RN, Grace DM. Examination of the excluded stomach after gastric bypass for obesity. J Can Assoc Radiol 1985; 36: 146–7.

    PubMed  CAS  Google Scholar 

  17. Fobi MA, Chicola K, Lee H. Access to the bypassed stomach after gastric bypass. Obes Surg 1998; 8: 289–95.

    Article  PubMed  CAS  Google Scholar 

  18. Sinar DR, Flickinger EG, Park HK et al. Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions. South Med J 1985; 78: 255–8.

    PubMed  CAS  Google Scholar 

  19. Madan AK, Lanier BJ, Tichansky DS et al. Laparoscopic Roux-en-Y gastric bypass with subtotal gastrectomy. Obes Surg 2005; 15: 1332–5.

    Article  PubMed  Google Scholar 

  20. Voellinger DC, Inabnet WB. Laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy for focal intestinal metaplasia of the gastric antrum. Obes Surg 2002; 12: 695–8.

    Article  PubMed  Google Scholar 

  21. Seva-Pereira G, Trombeta VL. Early gastric cancer found at preoperative assessment for bariatric surgery. Obes Surg 2006; 16: 1109–1.

    Article  PubMed  Google Scholar 

  22. Csendes A, Burdiles P, Papapietro K et al. Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg 2005; 9: 121–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Atul K. Madan MD FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Harper, J.L., Beech, D., Tichansky, D.S. et al. Cancer in the bypassed stomach presenting early after gastric bypass. OBES SURG 17, 1268–1271 (2007). https://doi.org/10.1007/s11695-007-9216-x

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9216-x

Key words

Navigation