Swedish adjustable gastric banding – an underestimated risk factor for the development of esophageal cancer?

Abstract

Background: Patients with obesity are at higher risk for gastroesophageal reflux disease and also for adenocarcinoma of the distal esophagus.Methods: Case report. Results: We report on a 58-year-old male patient who developed adenocarcinoma of the distal esophagus (Barrett's cancer) 13 years after implantation of a SAGB (Swedish adjustable gastric banding). Predisposition to reflux combined with bad compliance (frequent overeating) lead to dilation of the pouch followed by impairment of the lower esophageal sphincter with a permanent exposition of the distal esophagus to refluxate. This "stasis esophagitis" over years finally ended in development of neoplasia. Consequently, the patient underwent an esophageal resection with gastric tube pull-up and intrathoracic anastomosis.Conclusions: From a functional point of view, preoperative work up before SAGB should include detailed history, endoscopy with biopsies of the z-line and esophageal manometry. In case of defective esophageal peristalsis or suspected incompliance of the patient, an implantation of a SAGB should not be performed.

Laparoscopic Adjustable Gastric Banding: an Underestimated Risk Factor for the Development of Esophageal Cancer?—a Nationwide Survey

“…Recent studies have attempted to focus on the development of esophageal cancer after bariatric surgery. Most of them are case reports or retrospective single-center analyses [1,4,6,9,22]. Our study includes 10.300 patients following LAGB out of the overall population of Austria (8.5 million).…”

“…So far, fewer than 15 cases of esophageal cancer after LAGB implantation have been described, but there is sound evidence that the development of Barrett's metaplasia following LAGB is much higher [1,2,4,9]. The development of esophageal cancer might be based on frequent overeating and a poorly managed gastric band with suboptimal follow-up leading to dilatation of the proximal gastric pouch.…”

“…Until today, fewer than 15 cases have been published [1][2][3][4][5][6]. Our deep understanding of the pathophysiology of gastroesophageal reflux disease (GERD) and the pathophysiology of esophageal cancer alerted us when we operated a patient who developed Barrett's cancer years after laparoscopic adjustable gastric banding (LAGB) [7][8][9][10].…”

“…Taken together, the integrity of the esophagogastric junction, the angle of His and the LES are altered and this causes permanent exposure of gastric content to the esophagus. In the long term, this might lead to stasis esophagitis and also cause cancer [9,18].…”

Revisional Gastric Bypass After Failed Adjustable Gastric Banding—One-Stage or Two-Stage Procedure?

“…Nevertheless, longterm follow-up studies (> 7 years) have shown band dysfunction (insufficient weight loss) and a high rate of band-related complications (esophagitis, band erosion, leakage, and band slippage) in around 50% of patients. Between 32 and 53% of the patients require surgical removal of the band within the first 7 years [1][2][3][4].…”