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Management of Marginal Ulceration

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Complications in Bariatric Surgery

Abstract

Marginal ulcers (MU) are a significant cause of morbidity in patients who have undergone gastric bypass procedures. Incidence has been reported between 0.6% and 25%, and they may occur at any point in time after RYGB. The etiology of MU development has been widely discussed and remains controversial. It is likely multifactorial, with smoking and NSAID use being the most well-established risk factors, and may differ for each individual. The most frequent symptom is abdominal pain, and endoscopy is the gold standard for diagnosis. Current practice is to prophylactically administer 6–12 months of empirical PPI therapy postoperatively to low-risk patients, with longer courses considered for those with multiple risk factors. Treatment of diagnosed MU consists of 8 weeks of high-dose PPI therapy, plus or minus the addition of a cytoprotective barrier medication. Reversible causes of MU should be identified and corrected. Persistent ulcer after trial of medical management may indicate a more complicated etiology and further workup is warranted. There are no official guidelines for appropriate length of medical treatment to attempt before considering revisional surgery. Various techniques for RYGB revision in the setting of MU have been described, but the most widely accepted surgery essentially involves excision of all affected tissue of the gastrojejunostomy and creation of a new gastrojejunal anastomosis. In more complicated MU cases or recurrence after revision, referral to a specialist is advised. Perforated and bleeding MUs present a slightly different dilemma and thus must be approached in a similar manner as any acute perforated or bleeding viscus.

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Authors and Affiliations

  1. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA

    Jenny Choi & Caitlin Polistena

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  1. Jenny Choi
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  2. Caitlin Polistena
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Correspondence to Caitlin Polistena .

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  1. Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA

    Diego Camacho

  2. Department of General Surgery, FIU Herbert Wertheim College of Medicine, Miami, Florida, USA

    Natan Zundel

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Choi, J., Polistena, C. (2018). Management of Marginal Ulceration. In: Camacho, D., Zundel, N. (eds) Complications in Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-75841-1_4

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  • DOI: https://doi.org/10.1007/978-3-319-75841-1_4

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