Adenocarcinoma of the gastroesophageal junction after bariatric surgery

• Published in: The American journal of surgery Vol. 196; no. 1; pp. 135 - 138
• Main Authors: Melstrom, Laleh G., M.D., M.S.C.I, Bentrem, David J., M.D, Salvino, Michael J., M.D, Blum, Matthew G., M.D, Talamonti, Mark S., M.D, Printen, Kenneth J., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2008; Elsevier; Elsevier Limited
• Subjects: Adenocarcinoma; Adenocarcinoma - etiology; Aged; Bariatric Surgery; Barrett Esophagus - etiology; Biological and medical sciences; Body mass index; Diet; Dysphagia; Esophageal cancer; Esophageal Neoplasms - etiology; Esophagogastric Junction; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal junction; Gastroesophageal Reflux - etiology; Gastrointestinal surgery; General aspects; Humans; Male; Medical sciences; Middle Aged; Obesity; Obesity, Morbid - complications; Obesity, Morbid - surgery; Ostomy; Pathology; Patients; Postoperative Complications; Retrospective Studies; Surgery; Tomography; Tumors; Adenocarcinoma; Gastroesophageal junction; Esophageal cancer; Bariatric surgery; Medicine; Esophageal disease; Digestive diseases; Malignant tumor; Esophagus cancer; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.07.026

Abstract Background The development of upper gastrointestinal malignancies after bariatric surgery has not been well characterized. Our objective was to review the experience of patients with distal esophageal cancer that was diagnosed after bariatric surgery. Methods A retrospective review was conducted to identify patients who had undergone bariatric surgery (1999 to 2006) and who later developed high-grade dysplasia or adenocarcinoma of the distal esophagus. Results Three patients (of 2,875 [0.1%]) developed esophageal cancer: 2 after Roux-en-Y gastric bypass and 1 after vertical banded gastroplasty. All three patients had complaints of reflux, and two were treated with esophagectomy. The third patient presented with invasive carcinoma and died 2 years after diagnosis. Conclusions Our findings emphasize the importance of precise endoscopic evaluation before bariatric surgery in patients with gastroesophageal reflux disease (GERD), of the necessity for continuing postsurgical surveillance in patients with known Barrett's esophagitis, and of early evaluation in patients who develop new symptoms of GERD after bariatric surgery.