Laparoscopic adjustable gastric banding: an underestimated risk factor for the development of esophageal cancer? – A Nationwide survey

Introduction:

Among the population of Austria (8,4 Mill.) about 870.000 (12%) have a body mass index (BMI) > 30 kg/m². For those with morbid obesity, Bariatric surgery is currently the only effective treatment in the long term. In 1994 the laparoscopic adjustable gastric banding (LAGB) was introduced in Austria and about 10.300 patients received it so far. One of our LAGB-patients developed adenocarcinoma of the distal esophagus 13 years after implantation. In order to calculate if patients after LAGB are at higher risk for carcinoma of the esophagus, we performed a nationwide survey.

Methods:

A questionnaire was sent to all surgical departments in Austria, primarily in order to detect cases with esophageal carcinoma after LAGB, but also to evaluate the policy in Austria concerning the preoperative work-up, the operation and the follow-up in LAGB patients.

Results:

Since 1994, 37 out of 119 surgical departments in Austria have been performing about 10300 LAGB implantations in total. Moreover, eight surgical departments are performing resective esophageal cancer surgery. Seven patients could be identified with development of upper gastrointestinal malignoma after LAGB implantation.

Discussion:

To our knowledge less than 20 cases of esophageal cancer after laparoscopic adjustable gastric banding have been described so far, but there is sound evidence that the development of Barrett's metaplasia after LAGB is much higher. The most recent WHO statistical report on esophageal cancer shows an incidence of 2,8: 100.000/per year in Austria, less than 1% of the annually emerging malignant tumors. Compared to the seven patients we detected, the incidence of developing a carcinoma of the esophagus after LAGB is about five to seven fold higher.

Conclusion:

In patients with a laparoscopic adjustable gastric banding, a diligent preoperative evaluation and aggressive postsurgical follow-up including gastroscopy and in selected cases esophageal manometry seems mandatory.