Alfredo Genco1, Lidia Castagneto-Gissey2, Michele Lorenzo3, Ilaria Ernesti4, Emanuele Soricelli5, Giovanni Casella1. 1. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy. 2. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy. Electronic address: lidia.castagnetogissey@uniroma1.it. 3. Azienda Ospedaliera Locale Napoli 3 (ASLNA3), Distretto Sanitario 56 (DS56), Unità Operativa Medicina Legale (UOML), Torre Annunziata, Naples, Italy. 4. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. 5. Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy.
Abstract
BACKGROUND: Sleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percentage of cases, configuring a clinical condition of Barrett's esophagus (BE) in a proportion as high as 15-18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC). OBJECTIVES: To raise awareness of BE as a precancerous lesion which may progress toward malignancy after this popular bariatric procedure. SETTING: Bariatric referral centers, Italy. METHODS: All patients referred to our bariatric center who developed an EAC after SG between 2012 and 2019 were reviewed and consecutively included in this study. The available scientific literature regarding this complication is additionally reviewed. RESULTS: The 3 male patients comprised in this case series underwent laparoscopic SG between 2012 and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21-54 years and 43.1-75.6 kg/m2, respectively. All patients were lost to follow-up early after surgery (3.7 ± 1.4 months), and were diagnosed with EAC at a mean of 27.3 ± 7.6 months after SG. The 4 reported cases in the scientific literature developed an EAC at a mean of 32.5 ± 23 months from SG. Overall, a diagnosis of EAC was made approximately 30.3 ± 17.1 months postoperatively, which seems relatively and worryingly early after surgery. CONCLUSION: Although the rate and probability of progression from BE to EAC is still not well defined, assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then the preoperative identification and stratification of cancer risk factors in this subset of patients is strongly encouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diagnosis and for epidemiologic data collection purposes.
BACKGROUND: Sleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percentage of cases, configuring a clinical condition of Barrett's esophagus (BE) in a proportion as high as 15-18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC). OBJECTIVES: To raise awareness of BE as a precancerous lesion which may progress toward malignancy after this popular bariatric procedure. SETTING: Bariatric referral centers, Italy. METHODS: All patients referred to our bariatric center who developed an EAC after SG between 2012 and 2019 were reviewed and consecutively included in this study. The available scientific literature regarding this complication is additionally reviewed. RESULTS: The 3 male patients comprised in this case series underwent laparoscopic SG between 2012 and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21-54 years and 43.1-75.6 kg/m2, respectively. All patients were lost to follow-up early after surgery (3.7 ± 1.4 months), and were diagnosed with EAC at a mean of 27.3 ± 7.6 months after SG. The 4 reported cases in the scientific literature developed an EAC at a mean of 32.5 ± 23 months from SG. Overall, a diagnosis of EAC was made approximately 30.3 ± 17.1 months postoperatively, which seems relatively and worryingly early after surgery. CONCLUSION: Although the rate and probability of progression from BE to EAC is still not well defined, assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then the preoperative identification and stratification of cancer risk factors in this subset of patients is strongly encouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diagnosis and for epidemiologic data collection purposes.
Authors: Michael Jureller; Shankar I Logarajah; Travis Allen Van Meter; Housam Osman; John Jay; Maitham Moslim; Ralph Aye; D Rohan Jeyarajah Journal: J Gastrointest Surg Date: 2022-08-12 Impact factor: 3.267