Introduction:
Among the population of Austria (8,4 Mill.) about 870.000 (12%) have a body mass index
(BMI) > 30 kg/m2. For those with morbid obesity, Bariatric surgery is currently the only effective
treatment in the long term. In 1994 the laparoscopic adjustable gastric banding (LAGB)
was introduced in Austria and about 10.300 patients received it so far. One of our
LAGB-patients developed adenocarcinoma of the distal esophagus 13 years after implantation.
In order to calculate if patients after LAGB are at higher risk for carcinoma of the
esophagus, we performed a nationwide survey.
Methods:
A questionnaire was sent to all surgical departments in Austria, primarily in order
to detect cases with esophageal carcinoma after LAGB, but also to evaluate the policy
in Austria concerning the preoperative work-up, the operation and the follow-up in
LAGB patients.
Results:
Since 1994, 37 out of 119 surgical departments in Austria have been performing about
10300 LAGB implantations in total. Moreover, eight surgical departments are performing
resective esophageal cancer surgery. Seven patients could be identified with development
of upper gastrointestinal malignoma after LAGB implantation.
Discussion:
To our knowledge less than 20 cases of esophageal cancer after laparoscopic adjustable
gastric banding have been described so far, but there is sound evidence that the development
of Barrett's metaplasia after LAGB is much higher. The most recent WHO statistical
report on esophageal cancer shows an incidence of 2,8: 100.000/per year in Austria,
less than 1% of the annually emerging malignant tumors. Compared to the seven patients
we detected, the incidence of developing a carcinoma of the esophagus after LAGB is
about five to seven fold higher.
Conclusion:
In patients with a laparoscopic adjustable gastric banding, a diligent preoperative
evaluation and aggressive postsurgical follow-up including gastroscopy and in selected
cases esophageal manometry seems mandatory.
