Background

Diagnosis and treatment of gastric malignancy in the remnant stomach of patients with history of Roux-en-Y gastric bypass presents a unique challenge. Patients may not present with typical symptoms of vomiting and instead are more likely to present with abdominal pain.

Methods

This is a case series of three patients who presented with gastric outlet obstruction after Roux-en-Y gastric bypass. Workup included CT scan for diagnosis of outlet obstruction and endoscopic diagnosis and therapy.

Results

These patients underwent double-balloon enteroscopy. Stents were placed to relieve obstruction at the pylorus and tissue sampling obtained to secure a diagnosis. Of these patients, two were found to have gastric adenocarcinoma; one was found to have a benign stricture. Discussion: Patients with history of gastric bypass and gastric malignancy may present with atypical symptoms of gastric outlet obstruction; our patients all presented with vague abdominal pain and distention. As patients with gastric bypass age, these cases may become more prevalent. Further research is needed to develop screening and treatment algorithms in these patients.

Conclusions

Gastric outlet obstruction of the remnant stomach should be considered in patients with history of gastric bypass who present with atypical symptoms. Double-balloon enteroscopy is a valuable tool, both for diagnosis and therapeutic intervention, in patients who present this way after gastric bypass.