Esophageal adenocarcinoma after laparoscopic adjustable gastric banding: a case report and literature review

Background: Laparoscopic adjustable gastric banding (LAGB) was one of the most widely used techniques for the treatment of morbid obesity. Pouch enlargement, band slip or band erosion are complications associated with this procedure. The occurrence of esophageal adenocarcinoma after this bariatric procedure has also been reported previously. Therefore, this case report focuses on the surgical technique used in the management of this complication. Case Description: We report a case of a 48-year-old woman who underwent LAGB for morbid obesity without any other medical history or drug/alcohol use, and no history of reflux prior to LAGB has been documented. The patient developed symptoms of epigastric pain, dysphagia, and recurrent vomiting 12 years after the LAGB. Staging studies revealed a T1N0 lesion on esophageal endoscopy ultrasonography, but no metastatic disease was found on the computed tomography of the chest and abdomen. The patient underwent a minimally invasive Ivor-Lewis esophagectomy, and pathology showed a high-grade adenocarcinoma over Barrett's esophagus with negative surgical margins. The patient remained asymptomatic without recurrence after 39 months of follow-up. Additionally, we conducted a literature review focused on the management of esophageal tumors after LAGB. The analysis suggests that early diagnosis is challenging, and curative surgery has only been described in 9 cases, with minimally invasive esophagectomy (MIE) reported in one of them. Conclusions: In the follow-up of patients treated with LAGB, the persistence of symptoms or the onset of new ones should alert us to perform a comprehensive study to allow for early diagnosis. Minimally invasive approach is a feasible option in the treatment of these patients.