Gastric Carcinoid and Obesity: Association or Coincidence? Report of Two Cases and Literature Review

Bariatric surgery is a prevalent procedure due to the high incidence of obesity and comorbidities. Upper gastrointestinal endoscopy is one of the procedures used to evaluate the patient before surgery. However, its role is questionable. The incidental findings during endoscopy are variable including inflammatory diseases, and ulcers, and epithelial and stromal tumors. Herein a report of two obese sisters with incidental gastric carcinoids was diagnosed in prebariatric surgery endoscopy. Case Summary. 35- and 41-year-old female patients presented with obesity and BMI of 102 and 46？kg/m2, respectively. Both patients underwent upper gastrointestinal endoscopy as part of presurgical evaluation. Multiple polyps were indentified in both patients, and biopsy was taken. Histological examination revealed tumors that were formed by nests of epithelial cells. The cells have eosinophilic cytoplasm and monomorphic nuclei, typical morphology of neuroendocrine tumors. Conclusions. (1) Upper gastrointestinal endoscopy is an important procedure for prebariatric surgery evaluation. (2) Gastric carcinoid is a rare tumor with higher incidence among obese patients. 1. Introduction Laparoscopic sleeve gastrectomy is a procedure that became more prevalent as a treatment for morbid obesity due to marked improvement in surgical techniques. However, patients going for this procedure need proper preoperative assessment including medical, laboratory, and psychological evaluation [1]. Upper gastrointestinal endoscopy (UGIE) is one of the investigations that should be considered for prebariatric surgery evaluation. But its role is still questionable. Incidental pathological findings during prebariatric surgery evaluation are many and variable including epithelial and stromal tumors, peptic ulcers, and inflammatory conditions. Humphreys et al. reported abnormalities by prebariatric UGIE in 56% of their series of patients, two of them were esophageal adenocarcinoma [2]. Mu？oz and his colleagues [3] were able to demonstrate different abnormalities in their 626 series of patients including duodenal and gastric ulcers, polyps, Barrette’s esophagus, and gastric cancer. Gastric carcinoid tumor is one of the rare tumors that were discovered during prebariatric UGIE. In a series of 426 patients who underwent bariatric operation, carcinoid tumor was diagnosed preoperatively in only one patient [4]. Similarly, there were additional four cases reported in the literature [5–7]. In this paper another two cases of such tumor are reported in two sisters going for sleeve gastrectomy with a review of