Background

Bariatric Surgery over the last two decades has grown significantly in popularity. Currently the two most performed procedures are the Roux en Y Gastric Bypass (RYGB) and the Sleeve Gastrectomy. However, this increasing subset of patient with surgically altered anatomy presents an interesting challenge for surgeons when faced patients at risk for Gastric Cancers. Here we present a patient who had previously had a RYGB and was recently found incidentally to be a carrier of a Catenin Alpha 1 (CTNNA1) gene mutation which put her at significant risk of developing Hereditary Diffuse Gastric Cancer (HDGC).

Methods

Our patient is a 67-year-old female, who had previously had a RYGB for morbid obesity in 2002. She was doing well from a bariatric standpoint since her initial surgery. In 2019 the patient underwent genetic test for skin cancer given her significant family history of malignancy. At the time, testing resulted in two positive genes, but given lack of information the significance was unclear. In 2023, the patient received notification that one of her genetic mutations, specifically the one encoding for CTNNA1, was pathogenic for increased risk of HDGC. After initial EGD showed no evidence of malignancy in the pouch, decision was made to perform diagnostic laparoscopy with total gastrectomy of gastric remnant as prophylactic measure given the difficulty of repeat short term endoscopic surveillance of the remnant stomach.

Results

We present a novel way in the management in this small subset of patients that prove difficult to surveil endoscopically.