Gastric Adenocarcinoma in an Excluded Stomach Diagnosed by Double Balloon Enteroscopy

Gastric bypass is a common surgical procedure for obesity. A patient presented many years after a Roux-en-Y gastric bypass surgery with clinical evidence of metastatic malignancy of unknown primary. When biopsy of a liver lesion suggested a gastrointestinal primary tumor, we performed an upper double balloon enteroscopy to examine the excluded stomach and found a primary gastric cancer. To our knowledge, this is the first report of using this method to identify such a tumor, and this report demonstrates the feasibility of such an approach.