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Gastroesophageal Cancer After Gastric Bypass Surgeries: a Systematic Review and Meta-analysis

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Abstract

Data comparing the occurrence of gastroesophageal cancer after gastric bypass procedures are lacking and are only available in the form of case reports. We perform in this study a systematic review and a meta-analysis of all the reported cases of gastroesophageal cancer following Roux-en-Y gastric bypass (RYGB) and loop gastric bypass-one anastomosis gastric bypass/mini gastric bypass (LGB-OAGB/MGB). We conducted a systematic review of all the reported cases in articles referenced in PubMed/Medline, Cochrane, and Scholar Google. Only cases of gastro-esophageal adenocarcinoma following RYGB or LGB-OAGB/MGB are included. Statistical analysis was done accordingly. Fifty cases were identified, along with 2 reported in this paper. Sixty-one percent (27/44) of the cancers after RYGB were in the gastric tube compared to 37.5% (3/8) after LGB-OAGB/MGB. This resulted in an odds ratio of 0.38 (p-value = 0.26), which failed to prove an increase in cancer occurrence in the gastric tube after LGB-MGB/OAGB compared to RYGB. The most common symptoms were dysphagia for cancers occurring in the gastric tube (15/30) and abdominal pain for those occurring in the excluded stomach (10/22). Twenty-nine/thirty of the cancers in the gastric tube were diagnosed by gastroscopy and 13/22 of the cancers in the excluded stomach were diagnosed by CT scan. Gastroesophageal cancers after gastric bypass procedures occur commonly in the excluded stomach where many are not identified by conventional means. Physician awareness and patient education as well as lifelong follow-up are essential for maintaining bypass surgeries on the beneficial side.

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Author notes

  1. Rodrigue Chemaly and Samer Diab contributed equally and are both co-first authors.

Authors and Affiliations

  1. Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon

    Rodrigue Chemaly, Samer Diab & Georges Al-Hajj

  2. Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon

    Rodrigue Chemaly & Georges Al-Hajj

  3. Department of Computer Science and Mathematical, Lebanese American University, Beirut, Lebanon

    Georges Khazen

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  1. Rodrigue Chemaly
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Key points

• Mini gastric bypass does not seem to put the gastric pouch at a higher risk of gastroesophageal cancer development.

• A big proportion of gastroesophageal cancers after bypass surgeries occurs in the excluded stomach.

• Duodenogastric reflux is a physiologic process that might become harmful after gastric bypass surgeries.

• Attention is needed regarding the risk of cancer in the excluded stomach after gastric bypass surgeries.

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Chemaly, R., Diab, S., Khazen, G. et al. Gastroesophageal Cancer After Gastric Bypass Surgeries: a Systematic Review and Meta-analysis. OBES SURG 32, 1300–1311 (2022). https://doi.org/10.1007/s11695-022-05921-4

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