Swedish adjustable gastric banding – an underestimated risk factor for the development of esophageal cancer?
BACKGROUND: Patients with obesity are at higher risk for gastroesophageal reflux disease and also for adenocarcinoma of the distal esophagus. METHODS: Case report. RESULTS: We report on a 58-year-old male patient who developed adenocarcinoma of the distal esophagus (Barrett's cancer) 13 years after implantation of a SAGB (Swedish adjustable gastric banding). Predisposition to reflux combined with bad compliance (frequent overeating) lead to dilation of the pouch followed by impairment of the lower esophageal sphincter with a permanent exposition of the distal esophagus to refluxate. This "stasis esophagitis" over years finally ended in development of neoplasia. Consequently, the patient underwent an esophageal resection with gastric tube pull-up and intrathoracic anastomosis. CONCLUSIONS: From a functional point of view, preoperative work up before SAGB should include detailed history, endoscopy with biopsies of the z-line and esophageal manometry. In case of defective esophageal peristalsis or suspected incompliance of the patient, an implantation of a SAGB should not be performed.