Neoplasia of the gastric remnant after bypass, repercussions of delay in diagnosis.

Abstract

Gastric bypass is currently the most performed bariatric technique, with effective results in weight loss and resolution of comorbidities. However, it can have serious complications, such as gastric remnant neoplasms, rare tumors (mostly adenocarcinomas) that develop in the portion of the stomach excluded after surgery. The diagnosis of these neoplasms is often delayed due to the difficulty of endoscopic access to the gastric remnant and the nonspecificity of the initial symptoms -such as anemia, weight loss and dysphagia- which can be confused with common effects of the bypass. As a result, cases are often detected in advanced stages, with locally invasive or metastatic disease, complicating treatment and worsening prognosis. The case report describes a 56-year-old man who underwent gastric bypass surgery 11 years ago and presented with dysphagia, weight loss and anemia. Despite an initial gastroscopy without significant findings, a CT scan revealed an obstructing gastric tumor. He underwent robotic-assisted surgery, where peritoneal implants and ascites were found. After several postoperative complications - including jaundice and tumor stenosis of the gastrojejunostomy - prostheses and a catheter were placed to relieve symptoms, but the patient died 10 days after hospital discharge. This is the first case detected among more than 800 procedures since 2006. The uncommon nature of these neoplasms, together with their difficult diagnosis, highlights the need to keep a high index of suspicion and rigorous follow-up in patients with risk factors, given the associated poor prognosis.