Abstract
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.