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Review
. 2023 Jun 28;12(13):4336.
doi: 10.3390/jcm12134336.

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Marita Salame  1 , Noura Jawhar  2 , Amanda Belluzzi  1 , Mohammad Al-Kordi  1 , Andrew C Storm  3 , Barham K Abu Dayyeh  3 , Omar M Ghanem  1
Affiliations
Review

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Marita Salame et al. J Clin Med. .

Abstract

Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.

Keywords: Roux-en-Y gastric bypass; bariatric surgery; marginal ulcer.

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Conflict of interest statement

B.K.A.D. has received consulting fees from Endogenex, Endo-TAGSS, Metamodix, and BFKW; consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; speaker honorariums from Olympus, Johnson & Johnson; speaker honorariums and grant/research support from Medtronic and EndoGastric Solutions; and research support/grants from Apollo Endosurgery and Spatz Medical. A.C.S. has received research grants from Apollo Endosurgery, Boston Scientific, Endogenex, Endo-TAGSS, and Enterasense, and consulting fees from Apollo Endosurgery, Boston Scientific, ERBE Elektromedizin, Intuitive, Medtronic, and Olympus. All other authors (M.S., N.J., A.B., M.A.-K. and O.M.G.) do not have conflict of interest to disclose.

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