Gastric adenocarcinoma in the excluded stomach after Roux-en-Y gastric bypass: a case series, systematic review, and diagnostic algorithm.

BACKGROUND

Primary remnant gastric cancer after Roux-en-Y gastric bypass presents a diagnostic challenge, and no consensus indications exist to guide the evaluation of the excluded anatomy when malignancy is suspected.

METHODS

We present a single-institution case series of 7 patients diagnosed with gastric adenocarcinoma of the excluded stomach after Roux-en-Y gastric bypass; all were diagnosed at an advanced stage within the last 3 years. A literature review was performed, and the combined findings were used to create a novel diagnostic algorithm.

RESULTS

A total of 55 patients with remnant gastric cancer were identified (7 institutional and 48 from the literature). The median time from gastric bypass to diagnosis was 15 years, and most patients had an advanced tumor stage. Before diagnosis, 24 patients (45%) had documented anemia, and 42 patients (78%) had abnormalities of the excluded stomach on cross-sectional imaging. The presence of either of these features may warrant remnant gastroscopy in appropriately selected patients.

CONCLUSION

Anemia and radiographic evidence of excluded stomach abnormalities are both common among patients eventually diagnosed with remnant gastric cancer, and either of these findings should prompt consideration of accessing excluded anatomy.