Ellison Halle B, Parker David M, Horsley Ryan D, McField Daaron, Friscia Michael E, Petrick Anthony T
Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
Int J Surg Case Rep. 2016;25:179-83. doi: 10.1016/j.ijscr.2016.05.057. Epub 2016 Jun 11.
More than one third of Americans are obese. Obesity is a risk factor for gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma (EA). The only durable treatment for morbid obesity and its comorbid conditions is bariatric surgery. There is no consensus among bariatric surgeons, however, regarding the role of preoperative screening upper endoscopy in bariatric surgery.
Two cases of incidental EA were identified by completion EGD following laparoscopic Roux-en-Y gastric bypass (LRYGB). EGD was done for anastomotic surveillance and provocative leak testing. Esophageal masses were identified and biopsies demonstrated adenocarcinoma. In both cases a laparoscopic transhiatal esophagectomy (LTHE) was completed using the gastric remnant as conduit; the biliopancreatic limb was divided proximal to the jejunojejunostomy and anastomosed to the proximal roux limb to complete the reconstruction.
Obesity is a risk factor for GERD and EA. The role of EGD prior to bariatric surgery is unclear. Studies have demonstrated routine EGD prior to bariatric surgery may diagnose foregut pathology; however, few of the findings alter the planned treatment. The cost effectiveness of this strategy is questionable. There are reports of EA developing after bariatric surgery; however, we found no previous case reports of EA identified at LRYGB.
Our institution has opted for selective preoperative endoscopy in patients with preoperative gastrointestinal symptoms. In post gastric bypass patients LTHE can be performed with good results.
超过三分之一的美国人患有肥胖症。肥胖是胃食管反流病（GERD）和食管腺癌（EA）的危险因素。治疗病态肥胖及其合并症的唯一持久方法是减肥手术。然而，减肥外科医生对于术前筛查性上消化道内镜检查在减肥手术中的作用尚未达成共识。
在腹腔镜Roux-en-Y胃旁路术（LRYGB）后通过完成式内镜下胃十二指肠镜检查（EGD）发现了两例偶发性EA。进行EGD是为了进行吻合口监测和激发性渗漏测试。发现了食管肿物，活检显示为腺癌。在这两例病例中，均使用胃残端作为管道完成了腹腔镜经裂孔食管切除术（LTHE）；在空肠空肠吻合术近端切断胆胰支，并将其与近端Roux支吻合以完成重建。
肥胖是GERD和EA的危险因素。减肥手术前EGD的作用尚不清楚。研究表明，减肥手术前常规进行EGD可能会诊断前肠病变；然而，很少有检查结果会改变计划的治疗方案。这种策略的成本效益值得怀疑。有减肥手术后发生EA的报道；然而，我们未发现之前有在LRYGB时发现EA的病例报告。
我们机构选择对有术前胃肠道症状的患者进行选择性术前内镜检查。在胃旁路术后患者中，可以进行LTHE，且效果良好。
