Gastric Adenocarcinoma in an Excluded Stomach Diagnosed by Double Balloon Enteroscopy

Case Report

Austin J Med Oncol. 2015;2(1): 1015.

Gastric Adenocarcinoma in an Excluded Stomach Diagnosed by Double Balloon Enteroscopy

Deena Midani1, Adam C. Ehrlich1, Truptesh H Kothari2* and Stephen J. Heller3

1Temple University School of Medicine, Philadelphia, PA,USA

2University of Rochester Medical Center, Rochester, NY,USA

3Fox Chase Cancer Center, Philadelphia, PA, USA

*Corresponding author: Truptesh H. Kothari MD, MS, Assistant Professor of Medicine, Director, Developmental Endoscopy Lab at University of Rochester (DELUR), Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, USA

Received: February 26, 2015; Accepted: April 06, 2015; Published: April 08, 2015


Gastric bypass is a common surgical procedure for obesity. A patient presented many years after a Roux-en-Y gastric bypass surgery with clinical evidence of metastatic malignancy of unknown primary. When biopsy of a liver lesion suggested a gastrointestinal primary tumor, we performed an upper double balloon enteroscopy to examine the excluded stomach and found a primary gastric cancer. To our knowledge, this is the first report of using this method to identify such a tumor, and this report demonstrates the feasibility of such an approach.


Gastric bypass with Roux-en-Y reconstruction (RYGB) is an increasingly common procedure for the treatment of morbid obesity [1,2]. Although rare, gastric cancers developing in the excluded stomach have been reported in the RYGB patient population. These cancers often present in advanced stages due to limited accessibility of the excluded stomach to direct visualization [3]. This case demonstrates the ability to diagnose gastric cancer in the excluded stomach without surgery using upper double balloon enteroscopy (UDBE).

Case Report

A 43 year old female with family history of ovarian and endometrial cancers initially presented with nausea, anorexia, and severe right lower quadrant pain. She had undergone RYGB fourteen years earlier but at presentation was morbidly obese by body mass index (BMI). Initial evaluation at an outside institution, including routine upper endoscopy exploring the gastric pouch and colonoscopy, was normal. Imaging including ultrasound and CT scan of the abdomen and pelvis, also done at an outside institution, revealed a right ovarian mass, abdominal and pelvic ascites, multiple liver nodules and omental nodularity concerning for carcinomatosis. Ultrasoundguided core needle biopsy of a liver lesion at our institution showed moderately differentiated adenocarcinoma with tumor cells positive for CK7, PCEA, CDX-2, CK-19, and focal CK20suggestive of a primary gastrointestinal or biliary neoplasm. Review of her previous CT scan suggested a mass in her excluded stomach (Figure 1).