Editors Comment: Carcinoma after Gastric Bypass

Rutledge 1991; 1: 171-6. 2. Greve JWM. Should laparoscopic surgeons re-invent bariatric surgical procedures? (Correspondence). Rutledge R. Reply. Obes Surg 2001; 11: 101-4. 3. Eckhauser FE, Knol JA, Strodel WE. Remedial surgery following failed gastroplasty for morbid obesity. Ann Surg 1983; 198: 585-91. 4. Moore EE. Failure of gastric partitioning for morbid obesity. Surg Gynecol Obstet 1981; 152: 86-90. 5. Drew RL, Linner JH. Revisional surgery for severe obesity with fascia banded stoma Roux-en-Y gastric bypass. Obes Surg 1992; 2: 349-54. 6. Lemmens L. Biliopancreatic diversion: 170 patients in a 7-year follow-up. Obes Surg 1993; 3: 179-80. 7. Forestieri P, Meucci L, De Luca M et al. Two years of practice in adjustable silicone gastric banding (LAPBAND): evaluation of variations of body mass index, percentage ideal body weight and percentage excess body weight. Obes Surg 1998; 8: 49-52. 8. O’Brien PE, Brown WA, Smith A et al. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 1999; 86: 113-8. 9. Linner JH, Drew RL. Reoperative surgery–indications, efficacy, and long-term follow-up. Am J Clin Nutr 1992; 55(Suppl 2): 606S-610S. 10. Verset D, Houben JJ, Gay F et al. The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. Dig Dis Sci 1997; 42: 2333-7. 11. Ovrebo KK, Hatlebakk JG, Viste et al. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastro-

plasty. Ann Surg 1998; 228: 51-8. 12. Capella JF, Capella RF Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg 1999; 9: 22-7; Discussion 28. 13. Sapala JA, Wood MH, Sapala MA et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998; 8: 505-16. 14. Fox SR, Oh KH, Fox K. Vertical banded gastroplasty and distal gastric bypass as primary procedures: a comparison. Obes Surg 1996; 6: 421-5. 15. Hannah EL, Imperato PJ, Nenner RP et al. Laparoscopic and open cholecystectomy in New York State: mortality, complications, and choice of procedure. Surgery 1999; 125: 223-31. 16. Eriksson S, Backman L, Ljungstrom KG. The incidence of clinical postoperative thrombosis after gastric surgery for obesity during 16 years. Obes Surg 1997: 7: 332-5; Discussion 336. 17. Smith SC, Goodman GN, Edwards CB. Roux-en-Y gastric bypass: a 7-year retrospective review of 3,855 patients. Obes Surg 1995; 5: 314-8. 18. Chua TY, Mendiola RM. Laparoscopic vertical banded gastroplasty: the Milwaukee experience. Obes Surg 1995: 5: 77-80. 19. Nguyen NT, Ho HS, Mayer KL et al. Laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Soc Laparoendosc Surg 1999; 3: 193-6. 20. Weiner R, Wagner D, Bockhorn H. Laparoscopic gastric banding for morbid obesity. J Laparoendosc Adv Surg Tech A 1999; 9: 23-30.

Editors Comment: Carcinoma after Gastric Bypass

firmed histologically in 42%. They also found intestinal metaplasia (previously identified by Morson as a premalignant feature4) in the bypassed gastric mucosa histologically in 10% of biopsies, but reported no cancer. The mucosa of the proximal pouch was normal. 3 M. Deitel, Editor References 1. Lord RV, Edwards PD, Coleman MJ. Gastric cancer in the bypassed segment after operation for morbid obesity: case report. Aust NZ J Surg 1997; 67:580-2. 2. Raijman I, Strother S, Donegan WL. Gastric cancer after gastric bypass for obesity: case report. Aust NZ J Surg 1997; 67: 580-2. 3. Flickinger EG, Sinar DR, Pories WJ et al. The bypassed stomach. Am J Surg 1985; 149: 151-6. 4. Morson BC, Sobin LH, Grundmann E et al. Precancerous conditions with epithelial dysplasia in the stomach. J Clin Pathol 1980; 33: 711-21.

Alex Macgregor has found two published reports of gastric cancer after gastric bypass for morbid obesity. Lord et al1 reported a case of two separate adenocarcinomas in the bypassed stomach, occurring 13 years after loop gastric bypass, in which intestinal metaplasia was identified in the gastric mucosa away from the cancers. Raijman, Strother and Donegan 2 reported a case of adenocarcinoma in the bypassed stomach occurring 5 years after a gastric bypass (confirmed to have been a Roux-en-Y by William L. Donegan, personal communication). Considering the large number of loop gastric bypasses of the 1970s and the Roux-en-Y gastric bypasses of the last 20 years, this indicates an extremely low incidence. Flickinger and co-workers,3 using the 140-cm pediatric colonoscope for retrograde duodenogastroscopy of the bypassed stomach after Roux-en-Y gastric bypass, observed superficial gastritis in 87% of patients, con-

280 Obesity Surgery, 11, 2001

(Received October 15, 2000; accepted April 28, 2000)