Sara Mansfield, MS, MD, Andrew Suzo, BS, Dathe Benissan-Messan, MD, Saranya Prathibha, BS, Bradley Needleman, MD, Sabrena Noria, MD, PhD. Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center
Introduction: Marginal ulceration (MU) occurs in 1%-16% of patients following Roux-en-Y gastric bypass (RYGB). The etiology, while largely unknown, implicates diabetes, smoking, NSAID use and history of peptic ulcer disease. While these factors are involved in late ulcer development, there is a relative paucity of information regarding causes of early ulcers. The aim of this study was to identify pre-operative endoscopic findings predictive of early post-operative (< 90 days) marginal ulceration (MU). We hypothesized that pre-operative gastritis was a risk factor for early MU.
Methods: A retrospective review was performed, from February 2013 to 2016, on all patients who underwent either primary or revisional RYGB at our institution. All patients included in the study underwent a pre-operative esophagogastroduodenoscopy (EGD). The experimental group included patients that required an EGD within 90 days of their surgery and had an identifiable gastrojejunal ulcer at endoscopy. Demographics, comorbidities, baseline reflux symptoms, pre-operative EGD findings, biopsy results and weight at 3, 6, and 12 months post-op were collected. The control group included all patients who underwent RYGB and/or who had no identifiable ulcer at EGD within 90 days.
Results: A total of 308 patients underwent RYGB. Twenty-nine (9.4%) patients developed MUs within 90 days of surgery. There was no difference in age (46.9 years + 10.9 versus 46.2 years +/- 11.1, p=0.26), gender (n=27, 93.1% versus n=253, 90.7% female, p>0.99), or pre-operative body mass index (48.9 kg/m2 +/-7.6 versus 48.0 + 8.4 kg/m2, p=0.46) in the experimental versus control group, respectively. Pre-operative biopsy results demonstrated no differences in the incidence of acute (p>0.99) or chronic gastritis (p=0.88), acute (p>0.99) or chronic esophagitis (p=0.25), Barrett’s esophagus (p>0.99), or helicobacter pylori positivity (p>0.99) between the two groups. However, pathologic diagnosis of chemical gastritis was significantly associated with the formation of early ulcers (p<0.002, OR 4.38, 1.83-10.29 95% CI). There was no difference in percent of excess weight loss at 3 (p=0.45, 20.8% control vs 30.4% ulcer), 6 (p=0.45, 38.8% vs 48.0%), or 12 months (p=0.83, 51.0% vs 47.9%) post-surgery.
Conclusions: Pathologic diagnosis of chemical gastritis on pre-operative EGD is significantly associated with the formation of early (<90 days) post-operative MUs following RYGB. Given the cost of treating stomal ulcers vis-à-vis repeat EGDs and medications (cytoprotective and acid suppressive medications), these results suggest an important role for routine pre-op EGD and treatment of gastritis prior to RYGB.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79778
Program Number: P504
Presentation Session: Poster (Non CME)
Presentation Type: Poster