Laparoscopic Distal Esophagectomy and Pouch Gastrectomy for High Grade Dysplasia After Gastric Bypass

Konstantinos Spaniolas, MD, William E O’malley, MD, Thomas J Watson, MD. University of Rochester Medical Center

 

Background: Barrett’s esophagus (BE) with high-grade dysplasia (HGD) until recently has been treated primarily with esophagectomy. Advancements in endoluminal therapy have facilitated endoscopic ablation or mucosal resection of early esophageal neoplasia, challenging the standard of care for this disease. The possibility of synchronous or metachronous invasive adenocarcinoma, however, mandates intense post-ablation follow-up and can be the source of significant anxiety for some patients.

Methods: We report a case of short-segment BE and HGD diagnosed after laparoscopic gastric bypass, treated with laparoscopic limited distal esophagectomy and pouch-gastrectomy.

Results: The esophagus was mobilized laparoscopically into the mediastinum, achieving adequate length, and was transected 2-3 cm above the gastroesophageal junction. The proximal Roux limb of the gastric bypass was divided, and continuity was re-established with a stapled esophagojejunostomy. The patient was discharged on post operative day 3 without complications. The final pathology report revealed HGD with negative margins. Follow-up flexible endoscopy 3 months later revealed no evidence of BE.

Conclusions: In patients having undergone Roux-en-Y gastric bypass and presenting with short segment BE and HGD, laparoscopic limited distal esophagectomy may be a viable alternative to endoscopic therapy or conventional esophagectomy.

 


Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V100

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