Kevin C. Brown’s research while affiliated with Yale-New Haven Hospital and other places

As severe obesity continues to be a serious and worsening medical challenge, there has been a corresponding interest in new therapies. Bariatric surgery remains the most effective and enduring therapy option. Newer techniques which aim to spare gastric anatomy have been introduced. One such procedure, known as the laparoscopic vertical clip gastroplasty (LVCG) or laparoscopic BariClip gastroplasty (LBCG), is intended to mimic the effects of a sleeve gastrectomy without requiring permanent anatomic alteration; however, this method is relatively new and not currently approved for use in the USA. Ten years after clip placement outside of the USA, a 44-year-old female presented to our bariatric clinic with intermittent nausea and abdominal pain. She was lost to follow-up after initial treatment at an outside institution but reported good initial weight loss with the clip; however, she noted slow weight regain over the past few years. The patient underwent an upper gastrointestinal fluoroscopy and upper endoscopy, which concluded complete erosion of the clip into the stomach. She underwent laparoscopic removal of the clip and has had an uneventful recovery with plans for bariatric surgery later. Laparoscopic vertical clip gastroplasty (LVCG) is not a well-known procedure in the USA, and this is the first known reported case of a complete intragastric erosion of the clip necessitating removal. Regular follow-up and surveillance are needed to monitor potential complications, early migration, and possible erosion of these devices into the stomach.

Gastroesophageal malignancy after sleeve gastrectomy is rare. A 70-year-old male with a BMI of 46 underwent laparoscopic sleeve gastrectomy with normal endoscopy. By 10 months postop, the patient had reduced BMI to 30.5. Eleven months postop, he presented with emesis and endoscopy showed severe stenosis at the gastroesophageal junction with EUS showing a circumferential mass. Patient had adenocarcinoma of the distal esophagus HER 3+ and MMR proficient, clinical T2N1. He underwent esophageal stent placement followed by FOLFOX switched to carboplatin-Taxol with radiation therapy complicated by a localized perforation requiring antibiotics. After PET scan of esophageal mass indicated response, he underwent an open distal esophagectomy, total gastrectomy with Roux-en-Y esophagojejunostomy, and placement of feeding tube. Pathology revealed poorly differentiated invasive adenocarcinoma with negative margins. In the USA, this represents only the second adenocarcinoma following a sleeve gastrectomy and the first in a non-immune compromised patient.