Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;36(12):9129-9135.
doi: 10.1007/s00464-022-09393-6. Epub 2022 Jun 28.

Management strategies of anastomotic ulcer after gastric bypass and risk factors of recurrence

Ophélie Bacoeur-Ouzillou  1   2   3 , Julie Perinel  4   5 , Elise Pelascini  4 , Mourad Abdallah  6   7 , Gilles Poncet  4   5 , Arnaud Pasquer  4   5 , Maud Robert  8   9   10
Affiliations

Management strategies of anastomotic ulcer after gastric bypass and risk factors of recurrence

Ophélie Bacoeur-Ouzillou et al. Surg Endosc. 2022 Dec.

Abstract

Background: Marginal ulcers (MU) after gastric bypass are a challenging problem. The first-line treatment is a medical therapy with eviction of risk factors but is sometimes insufficient. The management strategies of intractable ulcers are still not clearly defined. The aim of our study was to analyse the risk factors for recurrence, the management strategies used and their efficiencies.

Methods: Based on a retrospective analysis of all MU managed in our tertiary care centre of bariatric surgery during the last 14 years, a descriptive analysis of the cohort, the management strategies and their efficiency were analysed. A logistic regression was done to identify the independent associated risk factors of intractable ulcer.

Results: Fifty-six patients matched inclusion criteria: 30 were referred to us (13 Roux-en-Y Gastric Bypass-RYGB and 17 One Anastomosis Gastric Bypass-OAGB), 26 were operated on in our institution (24 RYGB and 2 OAGB). 11 patients had a complicated inaugural MU requiring an interventional procedure in emergency: 7 perforations, 4 haemorrhages. The majority of MU were treated medically as a first-line therapy (n = 45; 80.4%). 32 MU recurred: 20 patients required surgery as a 2nd line therapy, 6 were operated on as a 3rd line therapy and 1 had a surgery as a 5th line therapy. The OAGB was the only risk factor of recurrence (p = 0.018). We found that the Surgical management was significantly more frequent for patients with a OAGB (84% versus 35% for RYGB, p = 0.001); the most performed surgical procedure was a conversion of OAGB to RYGB (n = 11, 37.9%).

Conclusion: Surgery was required for a large number of MU especially in case of recurrence, but recurrence can still occur after the surgery. The OAGB was the only risk factor of recurrence identified and conversion to RYGB seemed to be effective for the healing.

Keywords: Bariatric surgery; Intractable marginal ulcer; Marginal ulcer; One anastomosis gastric bypass; Recurrence; Roux-en-Y gastric bypass.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Coblijn UK, Lagarde SM, de Castro SMM, Kuiken SD, van Wagensveld BA (2015) Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg 25(5):805–811 - DOI - PubMed
    1. MacLean LD, Rhode BM, Nohr C, Katz S, McLean AP (1997) Stomal ulcer after gastric bypass. J Am Coll Surg 185:1–7 - DOI - PubMed
    1. Sapala JA, Wood MH, Sapala MA, Flake TM Jr (1998) Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 8(505–516):6
    1. Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA (2014) Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg 24(2):299–309 - DOI - PubMed
    1. Azagury D, Abu Dayyeh B, Greenwalt I, Thompson C (2011) Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy 43(11):950–954 - DOI - PubMed

LinkOut - more resources