# Laparoscopy With Percutaneous Transgastric Endoscopy for the Assessment of Gastric Cancer in the Excluded Stomach of a Roux-en-Y Gastric Bypass Patient

## TL;DR

A combined laparoscopic and endoscopic method is used to diagnose gastric cancer in the excluded stomach of a Roux-en-Y gastric bypass patient.

## Contribution

This case demonstrates a novel diagnostic approach for gastric cancer in the excluded stomach of Roux-en-Y gastric bypass patients.

## Key findings

- Laparoscopic-assisted endoscopic evaluation is feasible for diagnosing gastric cancer in the excluded stomach of RYGB patients.
- The combined approach offers potential diagnostic and therapeutic advantages in complex anatomical cases.
- Gastric cancer in RYGB patients is often diagnosed at an advanced stage due to its asymptomatic nature.

## Abstract

Primary adenocarcinoma in the excluded stomach of Roux-en-Y gastric bypass (RYGB) patients is extremely rare. As such, the most effective diagnostic approach has not yet been determined. In typical patients, endoscopic ultrasound (EUS) is the first-line technique for evaluating suspected gastric cancer. However, RYGB patients require a more personalized approach. Endoscopic evaluation of the excluded stomach in RYGB patients, whether by EUS-directed, enteroscopy-assisted, or percutaneous means, is undoubtedly more complex than in patients with normal anatomy. In addition, gastric cancer is often diagnosed at an advanced stage due to its asymptomatic early course. With the added complexity of endoscopy in RYGB patients, a laparoscopic-assisted endoscopic approach may have a more favorable diagnostic and therapeutic utility in the case of gastric remnant malignancy in RYGB patients. The following case describes this comprehensive laparoscopic and endoscopic approach for the diagnosis of gastric cancer of the excluded stomach in an RYGB patient.