High grade dysplasia or esophageal adenocarcinoma in patients with a history of Roux-en-Y gastric bypass surgery: a case series
Background Roux-en-Y gastric bypass (RYGB) is the favored bariatric option in patients with gastroesophageal reflux and Barrett’s esophagus because it prevents reflux. Weight loss and decreased reflux following RYGB could theoretically minimize the risk of progression to cancer. We aimed to demonstrate the management of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) developing in patients after RYGB.
Methods A prospectively maintained database was searched to identify cases of HGD and cancer in RYGB patients. Charts were reviewed for past history, endoscopic findings, endoscopic therapy, and pathology findings.
Results There were five cases where HGD/EAC developed several years after RYGB. The prior bariatric surgery precluded curative esophagectomy, illustrating the management challenges. All but one of the patients were uniquely and successfully managed with endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).
Conclusions RYGB patients are still at risk of developing esophageal cancer. Patients at risk should be screened prior to RYGB and those with Barret’s esophagus need to undergo rigorous endoscopic surveillance following surgery. If detected early, EMR and ESD are invaluable in managing those who progress.
Eingereicht: 26. September 2019
Angenommen: 29. Mai 2020
14. Juli 2020 (online)
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- 1 Wang Y, Beydoun MA, Liang L. et al. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity 2008; 16: 2323-2330
- 2 DeMaria EJ. Bariatric surgery for morbid obesity. J Med 2007; 356: 2176-2183
- 3 Peterli R, Wölnerhanssen BK, Peters T. et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: The SM-BOSS randomized clinical trial. JAMA 2018; 319: 255-265
- 4 Csendes A, Burgos AM, Smok G. et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg 2006; 10: 259-264
- 5 Hofsø D, Nordstrand N, Johnson LK. et al. Obesity-related cardiovascular risk factors after weight loss: A clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol 2010; 163: 735-745
- 6 Hutter MM, Schirmer BD, Jones DB. et al. First report from the American College of Surgeons Bariatric Surgery Center Network. Ann Surg 2011; 254: 410-422
- 7 Korner J, Bessler M, Cirilo LJ. et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab 2005; 90: 359-365
- 8 Scozzari G, Trapani R, Toppino M. et al. Esophagogastric cancer after bariatric surgery: Systematic review of the literature. Surg Obes Relat Dis 2013; 9: 133-142
- 9 Melstrom LG, Bentrem DJ, Salvino MJ. et al. Adenocarcinoma of the gastroesophageal junction after bariatric surgery. Am J Surg 2008; 196: 135-138
- 10 Nguyen NT, Tran CL, Gelfand DV. et al. Laparoscopic and thoracoscopic ivor lewis esophagectomy after Roux-en-Y gastric bypass. Ann Thorac Surg 2006; 82: 1910-1913
- 11 Takahashi H, Arimura Y, Masao H. et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264.e2
- 12 Casagrande DS, Rosa DD, Umpierre D. et al. Incidence of cancer following bariatric surgery: Systematic review and meta-analysis. Obes Surg 2014; 24: 1499-1509
- 13 Csendes A, Bragheto I, Burdiles P. et al. Regression of intestinal metaplasia to cardiac or fundic mucosa in patients with Barrett’s esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion. A prospective study of 78 patients with more than 5 years of follow up. Surgery 2006; 139: 46-53
- 14 Rossidis G, Browning R, Hochwald SN. et al. Minimally invasive esophagectomy is safe in patients with previous gastric bypass. Surg Obes Relat Dis 2014; 10: 95-100
- 15 Kestens C, Leenders M, Offerhaus GJA. et al. Risk of neoplastic progression in Barrett’s esophagus diagnosed as indefinite for dysplasia: A nationwide cohort study. Endoscopy 2014; 140: 409-414