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Case Reports
. 2023 Sep 24;2023(9):rjad518.
doi: 10.1093/jscr/rjad518. eCollection 2023 Sep.

Gastroesophageal junction adenocarcinoma 1-year after sleeve gastrectomy

Kevin C Brown  1 , Gabriela Esnaola  1 , Dan Boffa  1 , John M Morton  1
Affiliations
Case Reports

Gastroesophageal junction adenocarcinoma 1-year after sleeve gastrectomy

Kevin C Brown et al. J Surg Case Rep. .

Abstract

Gastroesophageal malignancy after sleeve gastrectomy is rare. A 70-year-old male with a BMI of 46 underwent laparoscopic sleeve gastrectomy with normal endoscopy. By 10 months postop, the patient had reduced BMI to 30.5. Eleven months postop, he presented with emesis and endoscopy showed severe stenosis at the gastroesophageal junction with EUS showing a circumferential mass. Patient had adenocarcinoma of the distal esophagus HER 3+ and MMR proficient, clinical T2N1. He underwent esophageal stent placement followed by FOLFOX switched to carboplatin-Taxol with radiation therapy complicated by a localized perforation requiring antibiotics. After PET scan of esophageal mass indicated response, he underwent an open distal esophagectomy, total gastrectomy with Roux-en-Y esophagojejunostomy, and placement of feeding tube. Pathology revealed poorly differentiated invasive adenocarcinoma with negative margins. In the USA, this represents only the second adenocarcinoma following a sleeve gastrectomy and the first in a non-immune compromised patient.

Keywords: cancer; endoscopy; sleeve gastrectomy.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Initial post-op endoscopy, GE circumferential mass (A), esophageal dilation (C), with retained material (B).
Figure 2
Figure 2
Upper GI fluoroscopy with tight GE junction stricture (arrow) and holdup of contrast.
Figure 3
Figure 3
Pre (A) and post (B) initial treatment PET-CT with response to neo-adjuvant therapy (area indicated by arrow).
See this image and copyright information in PMC

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