• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Marginal Ulcer After Roux-en-Y Gastric Bypass: What Have We Really Learned?

Kevin M El-hayek, MD, Poochong Timratana, MD, Hideharu Shimizu, MD, Bipan Chand, MD FACS. Cleveland Clinic

 

INTRODUCTION: The definition of marginal ulcer (MU) following Roux-en-Y gastric bypass is widely debated. A significant variation of incidence is reported with ulcers being categorized as early or late based on timing from operation. The objective of our study was to review the results of upper endoscopy in symptomatic patients. We further investigated potential etiologies including patient characteristics and operative details.

METHODS AND PROCEDURES: Patients who presented with symptoms underwent upper GI endoscopy following Roux-en-Y gastric bypass. An IRB approved database was queried over the preceding 15 months (6/01/2010-8/31/2011). Collected details included patient demographics, operative conduct, presenting symptoms, and upper endoscopy findings. Statistical analysis was performed using SPSS version 18.

RESULTS: A total of 455 upper GI endoscopies were performed on 328 symptomatic patients. MU was found in 112 patients (34%). Diagnosis of MU occurred in 59 patients (53%) within 12 months of surgery, and in 53 patients (47%) greater than 12 months after surgery. The method of construction of the gastrojejunostomy was determined in 191 patients. A circular stapled technique was used in 68 patients and a linear stapled technique was used in 123 patients, of whom 22 (32%) and 49 (40%) developed MU respectively (p=0.31). In the remaining 137 patients, whose operations were done outside our institution, the type of anastomosis was unknown. Twenty-one patients used tobacco, 92 used alcohol, and 10 used NSAIDs. The incidence of MU in these patients was 9/21 (43%), 32/92 (35%), and 6/10 (60%) respectively (p>0.05). The most common presenting symptoms included pain, dysphagia, nausea, and vomiting. MU was identified in 48/113 (43%) and 20/56 (36%) of patients presenting with pain and dysphagia respectively. Suture material or staples were identified in 40 patients; however, only 14 (35%) had MU. All patients with MU were started on acid suppression and cytoprotective therapy. Forty-seven patients with MU underwent repeat endoscopy due to persistent symptoms. Of these patients, 23 (49%) had resolution of the ulcer, 18 (38%) persisted, and 6 (12%) recurred after healing on third endoscopy. Given the poor correlation of known etiologic factors (smoking, alcohol, and NSAIDs) with healing, we began random pouch biopsy for the presence of parietal cells, regardless of endoscopic findings. Biopsy was performed in 55 patients, 28 (51%) of whom had MU. Parietal cells were identified in 11/28 (39%) with MU and 7/27 (26%) without MU (p=0.29). Using univariate and multivariate analysis among healing, non-healing, and healing with recurrence, tobacco was the solitary significant risk factor for recurrence (p=0.01). Five patients underwent revisional surgery for persistent MU, and 4/5 (80%) had recurrent MU.

CONCLUSION: Patients with pain or dysphagia after gastric bypass warrant upper endoscopy given the high yield for abnormalities. While the risk factors remain unclear, a thorough investigation including tobacco, alcohol, and 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. History of tobacco use remains the sole independent risk factor for ulcer persistence.
 


Session Number: SS09 – Obesity Surgery
Program Number: S050

7,557

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2012 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons