Intestinal metaplasia (IM) is a precancerous lesion that has been independently associated with gastric cancer development. The presence of IM in the preoperative study of Roux-n-Y gastric bypass (RYGB) raises question of whether or not remove the gastric remnant (GR) due to the impossibility of endoscopic surveillance.


Descriptive analysis of 6 consecutive cases of GR gastrectomy in RYGB from 2012 to 2021.


Seven cases (85.7% women) with an age of 56(41-63) years and pre-surgical BMI of 38.9(34.8-43.2)Kg/m2. The endoscopy confirms IM in 71.4% of the patients. There are two cases which the indication for GR gastrectomy was due to multiple hyperplastic polyposis. Surgical time of the RYGB with GR resection was 140(95-260) minutes. Hospital stay was 2(2-6) days. No postoperative complications or mortality were observed at 30 days. Histological analysis of GR demonstrates IM and atrophic gastritis in 57.1% and 42.9%, respectively. Regarding gastric polyposis cases, one case reveals a well-differentiated neuroendocrine tumor (Ki67 1-2%) in one polyp, pT1NxM0, and the other one dismisses any malignancy. Weight loss results at 6 months of follow-up are equivalent to regular RYGB, BMI of 32.9(28.6-33.8)Kg/m2.


GR gastrectomy indication in RYGB must be individualized. IM is an independent risk factor and, given the impossibility of endoscopic surveillance, the addition of GR gastrectomy should be considered. It is a procedure that, in expert hands, is reproducible and safe with the same postoperative results as a regular RYGB. However, larger samples and long-term follow-up are needed to confirm these results.