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      Gastric Carcinoid and Obesity: Association or Coincidence? Report of Two Cases and Literature Review

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          Abstract

          Bariatric surgery is a prevalent procedure due to the high incidence of obesity and comorbidities. Upper gastrointestinal endoscopy is one of the procedures used to evaluate the patient before surgery. However, its role is questionable. The incidental findings during endoscopy are variable including inflammatory diseases, and ulcers, and epithelial and stromal tumors. Herein a report of two obese sisters with incidental gastric carcinoids was diagnosed in prebariatric surgery endoscopy. Case Summary. 35- and 41-year-old female patients presented with obesity and BMI of 102 and 46 kg/m 2, respectively. Both patients underwent upper gastrointestinal endoscopy as part of presurgical evaluation. Multiple polyps were indentified in both patients, and biopsy was taken. Histological examination revealed tumors that were formed by nests of epithelial cells. The cells have eosinophilic cytoplasm and monomorphic nuclei, typical morphology of neuroendocrine tumors. Conclusions. (1) Upper gastrointestinal endoscopy is an important procedure for prebariatric surgery evaluation. (2) Gastric carcinoid is a rare tumor with higher incidence among obese patients.

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          Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass.

          Cengiz Erenoglu, Bruce Schirmer, Anna Miller (2002)
          Flexible upper endoscopy (FUE) is an important diagnostic and therapeutic tool in the management of upper gastrointestinal diseases. We examined the role of FUE in the management of patients undergoing Roux-en-Y gastric bypass (RYGBP). All patients undergoing RYGBP at a single institution from 1986 to 2001 were studied. Preoperative FUE was performed by the surgeon to assess the anatomy of the esophagus, stomach, and duodenum. Since 1997, gastric biopsies were obtained, testing for the presence of H. pylori. Colonized patients were treated preoperatively. Postoperatively, FUE was performed by the surgeon as indicated clinically, for management of symptoms suggesting anastomotic stenosis, upper gastrointestinal bleeding, inflammation, or ulcers. Endoscopic balloon dilatation was performed as indicated. 560 patients underwent RYGBP during the study period. Of these, 536 underwent preoperative FUE. Endoscopic findings changed or altered the operative procedure in 26 patients (4.9%). Preoperative testing for H. pylori was performed on 206 patients, of whom 62 (30.1%) were positive. Patients tested for H. pylori had a lower incidence of postoperative marginal ulcers (n = 5, 2.4%) than did patients who did not undergo such screening (n = 354, 6.8%, P < 0.05). Postoperatively, 54 patients underwent 80 endoscopic balloon dilatations for stenosis of the gastrojejunostomy. In addition, 18 patients underwent 28 FUEs that proved negative for such stenosis. In addition, 64 patients underwent 88 additional diagnostic or therapeutic FUEs in the postoperative period, including investigation of symptoms of pain, bleeding, persistent vomiting, or weight regain. Upper endoscopy is a tool which may be used by the surgeon in the preoperative and postoperative management of patients undergoing RYGBP to modify therapy, improve outcomes, and diagnose and treat postoperative complications.
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            Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated?

            José Salinas, Gustavo Pérez-Gil, Camilo Boza … (2009)
            Morbid obesity is associated with different gastrointestinal alterations and diseases. Surgically induced weight loss has become the best treatment for morbidly obese patients. Roux-en-Y gastric bypass is the most common procedure performed worldwide. Concerns regarding difficulties in further evaluation of stomach remnant for early detection of gastric cancer, however, have emphasized the routine use of preoperative upper endoscopy, even in asymptomatic patients, to detect upper gastrointestinal abnormalities. The main outcome of this study was to identify the most common preoperative endoscopic findings. Data was collected from a prospective database and medical records of patients with available endoscopic reports, who underwent Roux-en-Y gastric bypass from February 1999 to June 2006. Logistic regression analysis was performed to detect preoperative clinical variables that might be associated with abnormal endoscopy. Six hundred twenty-six patients were identified. Four hundred fifty-two (72%) were female; age and body mass index were 38.5 +/- 11.3 years and 42 +/- 6.5 kg/m(2), respectively. Abnormalities were found in 288 (46%) patients. The age of patients with abnormal and normal endoscopy was 40 +/- 11 and 36.8 +/- 11 years, respectively (p < 0.001). The most common findings were gastritis 21% (n = 132), esophagitis 16% (n = 100), and hiatal hernia 10.7% (n = 67). Duodenitis has a frequency of 7.8% (n = 49), gastric ulcers of 2.7%(n = 17), duodenal ulcers of 2.6% (n = 16), gastric polyps of 1.3% (n = 8), Barrett's esophagus of 0.16% (n = 1), and gastric cancer of 0.16% (n = 1). Age was the only clinical variable associated to abnormal endoscopy (odds ratio = 1.03; 95% confidence interval, 1.02-1.05). Routine preoperative endoscopy detects different abnormalities which need specific approach prior to surgery. Preoperative endoscopy should be performed to all patients prior to surgery.
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              Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity.

              Marcelo Beltran, Rafael A. Burgos, Attila Csendes … (2006)
              Roux-en-Y gastric bypass is the most frequent bariatric operation. In this operation, the distal bypassed stomach is left in situ. We studied pre-operative clinical, endoscopic and histologic findings in a consecutive group of morbidly obese patients prior to bariatric surgery. A prospective study was conducted from August 1999 until May 2004, which consisted of 426 patients with morbid obesity. There were 94 men and 332 women, with mean age 39.5 years. In all patients prior to surgery, upper endoscopy was performed and biopsy samples were taken distal to squamo-columnar junction (cardiac biopsies), and in 232 of them also in at the antrum. Pathological findings at the esophagus were seen in 55% of the patients, mainly related to reflux esophagitis. Barrett's esophagus was seen in 5.8%. In the stomach, pathological findings were seen in 32% of the patients. Active peptic ulcer was demonstrated in 2.6% of the cases. At the duodenum, pathologic findings were detected in 13.4% of the patients, showing an ulcer in 2.6%. At the stomach, chronic inactive gastritis and atrophic gastritis with intestinal metaplasia were found in 8.6% and 6.5% respectively. Antral adenoma with low-grade dysplasia was found in 1 patient, and 1 carcinoid tumor. H. pylori was present in 53% of the patients, mainly in the antrum. In candidates for bariatric surgery, upper endoscopy with biopsy samples and determination of H. pylori should be routinely performed. If present, H. pylori should be eradicated. After surgery, if Barrett's esophagus was present, endoscopic surveillance is recommended.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Gastrointest Med
                Journal ID (iso-abbrev): Case Rep Gastrointest Med
                Journal ID (publisher-id): CRIM.GM
                Title: Case Reports in Gastrointestinal Medicine
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6528
                ISSN (Electronic): 2090-6536
                Publication date (Print): 2013
                Publication date (Electronic): 15 January 2013
                Volume: 2013
                Electronic Location Identifier: 848075
                Affiliations
                1Department of Surgery, Farwaniya Hospital, 81004 Sabah Al-Naser, Kuwait
                2Department of Pathology, Farwaniya Hospital, P.O. Box 3313, 22034 Salmiya, Kuwait
                Author notes

                Academic Editors: S. Kikuchi and R. J. L. F. Loffeld

                Author information
                https://orcid.org/0000-0001-8371-812X
                Article
                DOI: 10.1155/2013/848075
                PMC ID: 3562567
                PubMed ID: 23401809
                SO-VID: 4e9a7c3e-7972-4483-a07e-c65707354101
                Copyright © Copyright © 2013 Obaid Al-Harbi et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 December 2012
                Date accepted : 27 December 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology

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