Saint Peters University Hospital New Brunswick, New Jersey
Introduction: Gastric cancer remains the fourth most common cancer worldwide. Unfortunately, it is usually diagnosed in advanced stage. Risk factors include Helicobactor pylori, gastroesophageal reflux disease, and obesity. Reported cases of gastric cancer after bariatric surgery have been known to be anecdotal. Laparascopic sleeve gastrectomy for obesity is increasingly preferred by surgeons due to it’s easy technique combined with excellent weight loss results. However, recently there has been a rising incidence of gastric-esophageal cancers seen post bariatric surgery. Cancer in the distal stomach after gastric bypass was first described in 1991 in a female patient five years after the original procedure. We present a case who was found to have gastric adenocarcinoma 7 years post sleeve gastrectomy.
Case Description/Methods: A 65-year-old Hispanic male presented to the emergency department with a complaint of vomiting for 10 days in duration. This was associated with epigastric pain and weight loss. His past medical history was significant for morbid obesity for which he underwent a gastric sleeve 7 years prior to presentation. He had GERD and H. pylori treated and eradicated with quadruple therapy. He did not report any family history of GI malignancies.
On examination, the vital signs and physical examination were unremarkable. His laboratory values were normal as well. Abdominal radiography, right upper quadrant ultrasound and computed tomography did not show evidence of intra-abdominal pathology. Upper endoscopy showed a circumferential mass in the fundus of the stomach. A biopsy confirmed gastric adenocarcinoma with focal signet cell features. He was started on neoadjuvant therapy and had a J tube put in place in order to tolerate feeds.
Discussion: The aim of this report is to show a case of de-novo gastric adenocarcinoma after bariatric surgery with sleeve gastrectomy. Although, obesity, a known risk factor for gastric carcinoma, increasing trends have been noted with rise in carcinoma after sleeve gastrectomy. It is not known whether bariatric surgery is the cause or the fact that patient had history of H pylori treated that predisposed him to develop the malignancy.
The relationship between bariatric surgery and subsequent gastric carcinoma needs further investigation. Patients might be at higher risk of developing gastric adenocarcinoma post sleeve gastrectomy especially if they have history of H. pylori infection in the past and this high risk group might benefit from surveillance EGD.
