LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 295
Comment on case report on mini-gastric bypass and esophagogastric junction carcinoma
Salvatore Tolone1, Mervyn Deitel2
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 Submission||22-Mar-2019|
|Date of Acceptance||24-Mar-2019|
|Date of Web Publication||05-Jun-2020|
Prof. Salvatore Tolone
Faculty of Medicine and Surgery, Universita Degli Studi Della Campania, Via Pansini 5, Naples
Source of Support: None, Conflict of Interest: None
|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
We read with interest, the report by Aggarwal et al., 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). 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.
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
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| ¤ References|| |
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].
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.
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.