Linitis Plastica Presenting as Pouch Outlet Stenosis 13 Years after Vertical Banded Gastroplasty

A 53-year-old woman, 13 years after vertical banded gastroplasty (VBG), presented with recently increased vomiting and high-grade pouch outlet stenosis, and was confirmed at laparotomy to have linitis plastics, for which she underwent total gastrectomy. Her pathology is unfavorable. Question is raised as to the incidence of gastric carcinoma subsequent to VBG and other gastric reductive and/or bypass procedures. Comparison is made of the increased incidence of gastric carcinoma over time, after gastric resective procedures for benign disease, versus the 'normal' incidence of gastric carcinoma, and the worse prognosis of gastric stump carcinoma. Noted is the recent observation, in a small series, of worrisome mucosal changes by endoscopic biopsies in patients after VBG, in the area of the pouch outlet. Long-term follow-up, with interval endoscopic biopsies and careful case reporting, will be important if we are to know the risk of eventual gastric carcinoma in these patients.