To report a case of Epstein-Barr virus-associated gastric carcinoma (EBVaGC) occurring one year after single anastomosis sleeve ileal bypass (SASI) and to discuss its implications in the context of existing literature.
Approach:
Case Presentation: A 62-year-old male with a BMI of 40.19 kg/m2 underwent SASI in July 2024. He remained asymptomatic until a routine gastroscopy in July 2025 revealed a 1.2 × 1.0 cm deeply excavated ulcer in the posterior gastric body, which was biopsied and confirmed as gastric adenocarcinoma.
Key Findings:
The patient developed EBVaGC one year post-SASI, despite being asymptomatic.
Histopathological examination confirmed EBVaGC with diffuse EBER positivity, preserved mismatch repair protein expression, wild-type p53, and a high proliferative index (Ki-67 ~90%).
Plasma EBV and postoperative circulating tumor DNA testing were negative.
Interpretation:
The case illustrates the occurrence of EBVaGC post-MBS and highlights the importance of tissue-based EBV testing in evaluating gastric lesions.
Limitations:
Limited number of documented cases of EBVaGC following metabolic bariatric surgery.
The study is based on a single case report, which may not be generalizable.
Conclusion:
Further studies are needed to evaluate the role of routine gastroscopic assessments in monitoring gastric mucosal health post-MBS.
