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 Table of Contents     
Year : 2020  |  Volume : 16  |  Issue : 3  |  Page : 295

Comment on case report on mini-gastric bypass and esophagogastric junction carcinoma

1 Department of Advanced Medical and Surgical Sciences, Faculty of Medicine and Surgery, Universitá Degli Studi Della Campania, Naples, Italy
2 MGB-OAGB Club, Toronto, ON, Canada

Date of Submission22-Mar-2019
Date of Acceptance24-Mar-2019
Date of Web Publication05-Jun-2020

Correspondence Address:
Prof. Salvatore Tolone
Faculty of Medicine and Surgery, Universita Degli Studi Della Campania, Via Pansini 5, Naples
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.JMAS_81_19

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How to cite this article:
Tolone S, Deitel M. Comment on case report on mini-gastric bypass and esophagogastric junction carcinoma. J Min Access Surg 2020;16:295

How to cite this URL:
Tolone S, Deitel M. Comment on case report on mini-gastric bypass and esophagogastric junction carcinoma. J Min Access Surg [serial online] 2020 [cited 2020 Sep 28];16:295. Available from:

Dear Sir,

We read with interest, the report by Aggarwal et al.,[1] of a 54-year-old male smoker and drinker, who had a rapid onset of non-bilious emesis due to carcinoma of the oesophagogastric junction (EGJ) within 2 years of undergoing mini-gastric bypass (MGB). The patient did not have a previous history of gastroesophageal reflux disease (GERD) and did not undergo pre-operative oesophago-gastroscopy. Aggarwal et al. postulate that the patient suffered a rapid bile-induced EGJ adenocarcinoma.

We have demonstrated that the MGB has a low-pressure channel with a lack of GERD (unlike the sleeve gastrectomy operation).[2] Recently published data about objective testing (by means of impedance-pH monitoring) performed pre- and post-MGB showed that weakly alkaline reflux as well as any other refluxate is very uncommon.

Gastroscopy prior to MGB is performed by many surgeons; however, other surgeons who have performed hundreds of negative endoscopies before MGB have discontinued this pre-operative procedure. Bile reflux to stomach does not appear to be associated with the development of cancer. Indeed, the second author (MD) performed thousands of vagotomy and pyloroplasties for peptic ulcer disease in the 1960s and 1970s, which was always followed by bile in the lower stomach; however, the development of carcinoma has not occurred in these patients.[3]

We agree that upper endoscopy before bariatric surgery should be undertaken in all obese patients with a history of reflux, inveterate cigarette smoking and significant alcohol intake. The rapid occurrence of the patient's cancer indicates that pre-operative upper endoscopy would have already discovered this lesion.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Aggarwal S, Bhambri A, Singla V, Dash NR, Sharma A. Adenocarcinoma of oesophagus involving gastro-oesophageal junction following mini-gastric bypass/one anastomosis gastric bypass. J Minim Access Surg 2019. doi: 10.4103/jmas.JMAS_320_18. [Epub ahead of print].   Back to cited text no. 1
Tolone S, Cristiano S, Savarino E, Lucido FS, Fico DI, Docimo L, et al. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis 2016;12:62-9.  Back to cited text no. 2
Deitel M. Absence of gastric and esophageal carcinoma after MGB-OAGB. In: Deitel M, editor. Essentials of Mini – One Anastomosis Gastric Bypass. Ch. 21. Cham, Switzerland: Springer; 2018. p. 181-3.  Back to cited text no. 3


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2004 Journal of Minimal Access Surgery
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