title: Laparoscopic transhiatal esophagectomy for esophageal adenocarcinoma identified at laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  More than one third of Americans are obese. Obesity is a risk factor for gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma (EA). The only durable treatment for morbid obesity and its comorbid conditions is bariatric surgery. There is no consensus among bariatric surgeons, however, regarding the role of preoperative screening upper endoscopy in bariatric surgery.
  
  
  METHODS
  Two cases of incidental EA were identified by completion EGD following laparoscopic Roux-en-Y gastric bypass (LRYGB). EGD was done for anastomotic surveillance and provocative leak testing. Esophageal masses were identified and biopsies demonstrated adenocarcinoma. In both cases a laparoscopic transhiatal esophagectomy (LTHE) was completed using the gastric remnant as conduit; the biliopancreatic limb was divided proximal to the jejunojejunostomy and anastomosed to the proximal roux limb to complete the reconstruction.
  
  
  CONCLUSIONS
  Obesity is a risk factor for GERD and EA. The role of EGD prior to bariatric surgery is unclear. Studies have demonstrated routine EGD prior to bariatric surgery may diagnose foregut pathology; however, few of the findings alter the planned treatment. The cost effectiveness of this strategy is questionable. There are reports of EA developing after bariatric surgery; however, we found no previous case reports of EA identified at LRYGB.
  
  
  CONCLUSIONS
  Our institution has opted for selective preoperative endoscopy in patients with preoperative gastrointestinal symptoms. In post gastric bypass patients LTHE can be performed with good results.
authors.affiliation: Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
authors.forename: Halle B
authors.initials: HB
authors.lastname: Ellison
authors.affiliation: Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States. Electronic address: dparker@geisinger.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Parker
authors.affiliation: Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Horsley
authors.affiliation: Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
authors.forename: Daaron
authors.initials: D
authors.lastname: McField
authors.affiliation: Geisinger Medical Center, Department of Thoracic Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Friscia
authors.affiliation: Geisinger Medical Center, Department of General Surgery, 100 North Academy Ave., Danville PA, 17821, United States.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Petrick
keywords: Case report; Esophageal adenocarcinoma; Laparoscopic Rroux-en-Y gastric bypass; Laparoscopic transhiatal esophagectomy