Uh-oh - Danger Will Robinson......

A funny thing happened on the way to my colonoscopy (no, this isn't a "guy walks into a bar" kind of story!)  In the pre-op consult with the gastroenterologist he suggested that he should do an EGD as long as I was on the table and under anesthesia. 2 for 1 special, up selling, and all of that, but he did have logical reasoning. I had some ancient history of reflux (years before my VSG, resolved by prior weight loss and maintenance, but still in his records,) and have never been able to fully get off of the PPIs after the sleeve (though am down to one OTC dose of omeprazole alternating with one OTC dose of Zantac per day, which does control symptoms well.)

Had he not suggested the 2fer sale I would have done so, as I was interested in finding out whether there were any physiological quirks keeping me on the meds - any odd post-op evolutions, hiatal hernias, etc. (I had been weaning off the PPI as they aren't the friendliest things long term.)

Indeed, he did find a small hiatal hernia, within which was a gastric polyp (nothing in the colon, though!) that he excised to the extent possible with his tools without risk of perforation. The biopsies typically done on such things found a small focus of cancer in there - OOPs! Not good, not good.

A quick trip to one of the local major cancer centers (fortunately there are several around LA) for an endoscopic ultrasound, where they can scrape away on the stomach wall with greater precision, reduced risk of perforating things and have the ability to do some lymph node imaging, cleaned up what the gastro couldn't get with his tools, and found no further spread or lymph node involvement. Subsequent PET/CT scans confirmed that assessment. Officially it was a T1a tumor, which means confined to the inner two of five layers of the stomach wall with no further spread or lymphatic involvement. Officially, they have declared it cured and gone. Yea! Sorta.

I remain an "interesting" patient, in that they don't see many cases like this, even at the major cancer centers. Typically, gastric cancer has a rather dismal prognosis due to it not having any real symptoms until it's at an advanced stage and too late to do much about it, and what symptoms it can show are fairly innocuous and much effort is usually expended treating symptoms before getting into more invasive scans. Indeed, one of the common questions I get asked when consulting another doc is "how ever did you find this?" Overall, US medicine doesn't have a lot of experience with this. This is a more common cancer in Japan and Korea due to some of their dietary quirks (and possibly some genetic influences,) so they routinely screen for it like we do for colon, breast and prostate cancer, and consequently they find a lot more of them early and know how to treat them. The question now comes down to how aggressively one goes about the risk reduction follow-on - diligent surveillance as would be done in Asia (assuming it can be done adequately here) or some form of more invasive surgical intervention. This decision is still pending.

The big question for all of us here is how does this relate to our sleeve and how likely will it happen to others here? Overall, not very likely it seems, but possibly more likely than for members of the general population. Searching OH and other forums, I have only found reference to one other person so afflicted, a bypass post-op from several years ago. (Countering this is observation is the sharp drop off of posting after a year or two post-op.) This is not something that pops up in the overall bariatric literature however prior gastric surgery is considered to be a risk factor (though most literature refers to surgeries treating various pre-cancerous conditions such as severe ulcerations). It should also be noted that, as with many cancers, obesity is a listed risk factor, so we are a bit damned if we do and damned if we don't do something about our weight problem.

Discussing this with our bariatric team didn't yield any significant history of the problem in their patient population, and they have been doing sleeves, by way of the DS for some 25 years. Overall, WLS doesn't seem to be as significant a risk factor as other gastric surgeries, but there probably is some elevated risk. Another possibility is that there might be some quirk about the sleeve that adds some risk, but we are currently only on the leading edge of experience on this, and more may show up over time. This is speculative, of course, and a very big TBD as to whether there is anything to it; if there is it should show over the next few years as the average sleeve is still quite young.

Short answer advice here would be that if one is having any signs of gastric distress over time and have the opportunity to have an EGD done, do it. If there is anything to this that relates to our sleeve, it is much better to be in front of the problem than trying to chase it down after it has gotten out of control, which is a race that few can win.

Thanks for the information. This is good to know. More importantly, I'm glad you are "cured" and are doing well. Yeah, I'd keep monitoring with regularity, too! 

Glad yours was caught and cured.  My dad had stomach cancer and had to have a total gastrectomy. Good post.  

A TG is on the table (the surgeon refers to it as the"nuclear option", as in leaves nothing behind,) along with less severe procedures such as a "bypassless" RNY or nothing beyond monitoring. The problem with monitoring comes down to how much one trusts the system with the limited experience that they have - even the major cancer centers may only see a couple of these cases per year (we tend not to find what we don't look for.) At least there is time in this case to consider these more significant options while surveillance continues.

Thank you so much for sharing your experience and all the research surrounding the issue! Happy that yours was caught early and taken care of. Best of luck to you!

Yikes!  Thank you so much for sharing your story.  I am so glad you went for the 2fer!

Thank you for sharing this with us. Important info to consider as we all get further out from surgery.  All the best to you