Gastric Cancer after Laparoscopic Adjustable Gastric Banding: A Case Series

Background: The association between bariatric procedures and adenocarcinoma of the distal esophagus and stomach is not fully understood. While reflux esophagitis and subsequent Barrett's esophagus may increase rates of gastric tumors, weight loss may have a protective role. Only a few case reports of gastric cancer following gastric banding have been reported. Objective: We report three patients who were diagnosed with esophago-gastric adenocarcinoma following laparoscopic adjustable gastric bending surgery. Methods: A retrospective review of the medical records of 3 patients who were diagnosed with gastric adenocarcinoma following LAGB. Results: All patients underwent workup that was initiated due to long standing complaints of persisting nausea and vomiting followed by intermittent epigastric pain. One patient was diagnosed by upper endoscopy with the tumor located at the gastro-esophageal junction. The second patient was found to have a gastric body lesion during laparoscopic removal of his gastric band and the pathology was confirmed by upper endoscopy and biopsies the following day. A third patient presented with an antral mass. All patients had localized lesions with regional lymphadenopathy and eventually underwent a gastrectomy with lymph node dissection. Conclusion: Since epigastric pain, nausea, weight loss, and vomiting are common complaints in bariatric surgery patients, these complaints often do not elicit further investigation. This may result in delayed workup and diagnosis of gastric malignancies. Clinicians must be aware of these entities, and consider routine gastroscopy in this patient population.