Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned? View Full Text


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Article Info

DATE

2012-10

AUTHORS

K. El-Hayek, P. Timratana, H. Shimizu, B. Chand

ABSTRACT

BACKGROUND: The definition of marginal ulcer after Roux-en-Y gastric bypass (RYGB) is widely debated. This study reviewed findings of upper endoscopy in symptomatic patients at a quaternary bariatric referral center. Further investigation included symptom constellation, potential etiologies, and efficacy of treatment for patients found to have marginal ulcer. METHODS: Patients presenting for upper gastrointestinal endoscopy after Roux-en-Y gastric bypass were included in this study. An institutional review board-approved database was queried for the period 1 June 2010 to 31 August 2011. Subgroup analysis was performed for patients with marginal ulcer. Statistical analysis was performed using PASW version 18 for Windows. RESULTS: During the study period, 455 upper gastrointestinal endoscopies were performed for 328 consecutive symptomatic patients. Marginal ulcer, found in 112 patients (34 %), was diagnosed for 59 of the patients (53 %) within 12 months after surgery and for 53 of the patients (47 %) more than 12 months after surgery. In patients found to have marginal ulcer, the most common presenting symptoms were pain, dysphagia, nausea, and vomiting. All the patients with marginal ulcer underwent acid suppression and cytoprotective therapy. Using uni- and multivariate analyses for healing, nonhealing, and healing with recurrence, tobacco use was found to be the solitary significant risk factor for recurrence (p = 0.01). CONCLUSION: Patients with pain or dysphagia after gastric bypass warrant upper endoscopy given the high yield for abnormalities. Although the risk factors for the development of marginal ulcer remain multifactorial, a thorough investigation for potential etiologies including tobacco, alcohol, and nonsteroidal antiinflammatory drug (NSAID) usage should be determined and eliminated. The presence of multiple risk factors may pose a higher challenge in ulcer resolution, leading to increased recurrence. In the current series, prior or current tobacco use remained the sole independent risk factor for ulcer persistence. More... »

PAGES

2789-2796

References to SciGraph publications

  • 2009-12. Metabolic/Bariatric Surgery Worldwide 2008 in OBESITY SURGERY
  • 2007-07. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients in SURGICAL ENDOSCOPY
  • 1994-02. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity in DIGESTIVE DISEASES AND SCIENCES
  • 2011-09. Late Marginal Ulcers after Gastric Bypass for Morbid Obesity. Clinical and Endoscopic Findings and Response to Treatment in OBESITY SURGERY
  • 1998-10. Marginal Ulcer After Gastric Bypass: A Prospective 3-Year Study of 173 Patients in OBESITY SURGERY
  • 2005-06. The Proximal Gastric Pouch Invariably Contains Acid-Producing Parietal Cells in Roux-en-Y Gastric Bypass in OBESITY SURGERY
  • 2005-11. Role of Gastric Acid in Stomal Ulcer after Gastric Bypass in OBESITY SURGERY
  • 2002-10. Flexible Endoscopy in the Management of Patients Undergoing Roux-en-Y Gastric Bypass in OBESITY SURGERY
  • 2002-02. Peptic Ulcer/Stricture After Gastric Bypass: A Comparison of Technique and Acid Suppression Variables in OBESITY SURGERY
  • 2010-11. Postprandial Proximal Gastric Acid Pocket in Patients after Roux-En-Y Gastric Bypass in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2006-10. Predictors of Endoscopic Findings After Roux-en-Y Gastric Bypass in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 1999-02. Gastro-Gastric Fistulas and Marginal Ulcers in Gastric Bypass Procedures for Weight Reduction in OBESITY SURGERY
  • 2011-07. Wireless pH-metry at the gastrojejunostomy after Roux-en-Y gastric bypass: a novel use of the BRAVO™ system in SURGICAL ENDOSCOPY
  • 2009-02. Incidence of Marginal Ulcer 1 Month and 1 to 2 Years After Gastric Bypass: A Prospective Consecutive Endoscopic Evaluation of 442 Patients with Morbid Obesity in OBESITY SURGERY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00464-012-2280-x

    DOI

    http://dx.doi.org/10.1007/s00464-012-2280-x

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/22543994


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