Evaluation of the excluded stomach by double-balloon endoscopy after laparoscopic Roux-en-Y gastric bypass

Tagaya, Nobumi; Kasama, Kazunori; Inamine, Susumu; Zaha, Osamu; Kanke, Kazunari; Fujii, Youichirou; Kanehira, Eiji; Hiraishi, Hideyuki; Kubota, Keiichi

doi:10.1007/bf02802085

Cited by 14 publications

(20 citation statements)

References 23 publications

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“…A double-balloon enteroscope is one of the feasible methods to examine a bypassed stomach, and this can also be performed in Japan [27]. In fact, some of our patients safely received an endoscopic examination using the doubleballoon technique.…”

Section: Discussionmentioning

confidence: 97%

Has Laparoscopic Bariatric Surgery been Accepted in Japan? The Experience of a Single Surgeon

et al. 2008

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Section: Discussionmentioning

confidence: 97%

Has Laparoscopic Bariatric Surgery been Accepted in Japan? The Experience of a Single Surgeon

et al. 2008

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“…The gastric bypass procedure excludes a segment of the proximal digestive tube, thereby making it difficult to diagnose pathological processes at this level. Various exploration techniques have been proposed for the evaluation of the stomach and duodenum in patients undergoing surgery for morbid obesity: a) in the Fobi s gastrostomy, a gastrostomy tube is located in the bypassed stomach, and also a radio-opaque marker is placed around the gastrostomy site enabling the radiological localization making an easily percutaneous access to the bypassed stomach (6); b) the use of a long retrograde endoscope (7); c) percutaneous puncture under endoscopic control to perform a gastrostomy and a later endoscopic control through the gastrostomy (8); d) double-balloon endoscopy and accessing to the bypassed stomach through the yeyuno-yeyunal anastomosis (9); or e) virtual CT-enabled gastroduodenoscopy (10). A PET-CT combination could be employed in the oncological study of the bypassed gastrointestinal segment without having to resort to the previously described invasive techniques.…”

Section: Discussionmentioning

confidence: 99%

Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

Menéndez¹,

Villarejo

Padilla

2013

Rev. esp. enferm. dig.

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Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery. A neoplasm within the gastric pouch is a somewhat infrequent complication but with important survival consequences. We present the case of a 51-year-old woman who developed an adenocarcinoma in the bypassed stomach three years after bariatric surgery; the tumour was incidentally discovered after gynaecological surgery for uterine myomas. Various diagnostic modalities for the excluded stomach were analysed.Key words: Bariatric surgery. Gastric cancer. Morbid obesity. Krukenberg tumour. INTRODUCTIONMedical treatment for morbid obesity can be effective in the short and medium term, but usually ends in failure, making the surgical option necessary. Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery; a neoplasm is a somewhat infrequent complication. A Krukenberg tumour is a metastatic signet-ring adenocarcinoma of the ovary with variants of gastro-intestinal primary, detected either synchronously or metachronously (1). We present a case of a Krukenberg tumour due to an adenocarcinoma in the bypassed stomach after bariatric surgery. CASE REPORTA 51-year-old woman suffering from Graves-Basedow disease, depressive disorder, right bundle branch, tubal ligation, cholecystectomy and obesity, had undergone a gastric bypass for morbid obesity three years ago; her initial body mass index (BMI) was 47.65 kg/m 2 (122 kg). She was taken to the Emergency Department due to a syncopal, dysphagia, vomiting and constitutional syndrome, with 55.5 kg weight (BMI 21.68 kg/m 2 ). It was necessary to carry out a hemoderivative transfusion due to 4.2 g hemoglobin/dL (hematocrit 13.3 %). Computed tomography (CT) and gastrointestinal transit were carried out during her hospital stay, indicating an ulcerated stenosis at the gastroyeyunal anastomosis, which was treated by endoscopic dilatation. Patient was discharged, and later, a hysterectomy with bilateral salpingo-oophorectomy was performed due to uterine myomas; histopathology revealed a metastatic adenocarcinoma in the left fallopian tube and a Krukenberg tumour in the left ovary. Due to the histopathological findings, a CT scan was performed and revealed a stenosis in the gastric bypass due to a mass in the bypassed stomach (Fig. 1). Following eight neoadjuvant cycles of chemotherapy (epirubicin, cisplatin and flurouracil, every 21 days), a total gastrectomy was done, resulting in the removal of gastric adenocarcinoma (Lauren type) with infiltration of all the gastric wall and the intestinal segment, and with metastasis in 15 lymphatic nodes. The classification of this tumour was pT4N2Mx. There was no evidence of recurrence six months after surgery and adjuvant treatment. Vol. 105. N.° 5, pp. 296-298, 2013 Received: 23-10-201223-10- Accepted: 27-11-2012 Correspondence: Pablo Menéndez Sánchez. Department of General and Digestive Surgery. Hospital Gutiérrez Ortega. Avenida de los Estudiantes, s/n. 13300 Valdepeñas, Ciudad Real. Spain e-...

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“…For patients who already underwent a bariatric procedure, such as RYGBP, the excluded stomach can be evaluated by using a new endoscopic approach, such as the double-balloon enteroscope [10][11][12]. This new technique permits the excluded stomach to be reached through the gastrojejunostomy and the alimentary limb exploration, but sometimes it is difficult because it depends on the length of the alimentary and biliopancreatic limbs, and the endoscopist's training.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transgastric access to the common bile duct after Roux-en-Y gastric bypass

et al. 2009

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Evaluation of the excluded stomach by double-balloon endoscopy after laparoscopic Roux-en-Y gastric bypass

Abstract: Use of the double-balloon technique makes it possible to observe the GI tract after laparoscopic LRYGBP irrespective of the length between the gastrojejunostomy and the jejunojejunostomy.

Cited by 14 publications

References 23 publications

Has Laparoscopic Bariatric Surgery been Accepted in Japan? The Experience of a Single Surgeon

Has Laparoscopic Bariatric Surgery been Accepted in Japan? The Experience of a Single Surgeon

Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

Laparoscopic transgastric access to the common bile duct after Roux-en-Y gastric bypass

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