Gastric cancer after gastric bypass with fundectomy: The possibility for early diagnosis

Roux-an-Y gastric bypass (RYGP) is one of the most important bariatric procedures and its results are well known in terms of weight loss and comorbid improvement. The major limitation of this technique is the difficult exploration of the excluded stomach and duodenum. Some Authors are performing the gastric bypass with fundectomy and, according to Literature, it is feasible and effective, with major advantage of explorable gastric pouch.

We report the case of a 54-year-old woman affected by obesity (BMI 49 kg/m²). After a pre-operative multidisciplinary evaluation and gastroscopy, she underwent a laparoscopic RYGB with fundectomy in October 2016. One year after surgery she contacted the department for vomiting, pyrosis and weakness. Thanks to the characteristics of the surgical technique it was possible to easily perform an OGD that detected an antral ulcer. The byopsy revealed a gastric adenocarcinoma. A degastroresection was performed and the istological finding was a gastric adenocarcinoma pT1b N0 G3.

Early diagnosis is essential in gastric tumors to ensure a good prognosis and the gold standard is performing gastroscopy with biopsies. With the standard technique is very challenging to perform an OGD and the cancer stage is likely to be advanced at diagnosis, with a bad prognosis for the patient.

From the clinical case described and the analysis of the Literature, the advantages of this technique are clear, allowing for an easy endoscopic evaluation of gastric walls with the possibility of diagnosing early stage tumors with a better outcome for patients.