Esophageal adenocarcinoma in Barrett’s esophagus after sleeve gastrectomy: Case report and literature review

Highlights • Literature evidences regarding the evolution of Barrett’s esophagus after sleeve gastrectomy is poor and the relation between sleeve gastrectomy and the development of subsequent esophageal cancer isn’t clear yet. • Preoperative upper endoscopy should be performed in order to detect gastroesophageal reflux disease, Barrett’s esophagus, before undergoing bariatric surgery. Post operative monitoring of the upper gastrointestinal tract after sleeve gastrectomy is essential.
Introduction : Sleeve gastrectomy (SG) has become one of the most dramatically increasing bariatric procedures worldwide due to its excellent results and impact on the obesity pandemic. Morbid obesity is known to increase the risk of esophageal adenocarcinoma. However, the evolution of gastroesophageal reflux disease (GERD) along with Barrett’s esophagus (BE) after SG is of concern since there is little data available. We present a case of esophageal adenocarcinoma after SG with known intestinal metaplasia on preoperative gastroscopy. Case presentation : We report a case of a 55 years old female patient who presented lower esophageal adenocarcinoma three years after complicated SG with known preoperative BE without dysplasia detected by gastroscopy. Multidisciplinary decision suggested treatment by endoscopic mucosectomy. The endoscopic control at one year did not highlight tumoral recurrence but still BE without dysplasia. Discussion : Literature review regarding the evolution of BE after SG is poor and the relation between SG and the development of subsequent esophageal cancer isn’t clear yet. Conclusion : Preoperative endoscopy should be performed in order to detect GERD, BE, and potential carcinomas of the upper gastrointestinal tract before undergoing bariatric surgery. The long-term monitoring after SG is essential.