Esophagectomy for Barrett's adenocarcinoma after multiple bariatric surgeries: A case report

• Published in: International journal of surgery case reports 2023-01, Vol.102, p.107838, Article 107838
• Main Authors: Steygers, Arnaud, De Moor, Véronique
• Format: Article
• Language: English
• Subjects: Adjustable gastric banding; Barrett's adenocarcinoma; Case Report; Esophagectomy; Gastric bypass; Sleeve gastrectomy
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107838

Bariatric surgery diminishes the incidence of many kinds of neoplasms, but gastro-esophageal cancers may occur after bariatric procedures. Most esophageal neoplasms arise on Barrett's esophagus, which may be worsened by bariatric surgery, especially restrictive procedures. Endoscopic resections may cure cancer in its early stages, but surgery may be required in more advanced cases. A 62-year-old patient with history of adjustable gastric banding, sleeve gastrectomy then Roux-en-Y gastric bypass presented with an early Barrett's adenocarcinoma. Endoscopic treatment was first applied but the patient required surgery due to positive margins on the resected specimen. As the early tumor was located in the esophagus' lower third, a limited resection with eso-jejunal anastomosis was planned. However, as the previous bariatric did not allow a proper reconstruction, a total esophagectomy with colonic interposition had to be performed. Eso-gastric malignancies remain rare after weight loss procedures, but more cases will arise due to the increasing incidence of bariatric surgery. Esophageal resection and reconstruction becomes increasingly challenging along with the number of bariatric procedures performed on the same patient. Endoscopic screening is of paramount importance before any obesity surgery or to assess any new onset of symptoms after a bariatric procedure, as endoscopic resections may cure cancer in its early stages. Endoscopic screening and treatment remains of paramount importance, especially after multiple bariatric procedures as surgery and reconstruction gets increasingly challenging. Whenever surgery is required, a proper planning and individual approach is compulsory, as well as a back-up plan. •First case report of esophagectomy for Barrett’s adenocarcinoma performed after three different bariatric procedures•Paramount importance of endoscopy to screen pre-cancerous lesions before a bariatric procedure•Endoscopic assessment required for every new onset of symptoms as early stages of cancer may be cured by endoscopic resection•Need for preoperative imaging and previous operative reports to assess the patient’s anatomy and plan the best reconstruction•Always make a backup plan preoperatively in case of intraoperative difficulties