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Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures

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Abstract

Introduction

Marginal ulcer (MU) is a serious complication after Roux-en-Y gastric bypass (RYGB) procedures. This study reports the incidence, risk factors, and treatment outcomes of symptomatic and incidentally, at routine endoscopy diagnosed, MU.

Methods

All patients undergoing RYGB procedures between 2013 and 2018 at a single center were included. Upper endoscopy was performed in case of symptoms and/or routinely 2 and 5 years postoperatively.

Results

In total, 568 patients (83.3% female) underwent RYGB procedure with a median age of 40 years and median initial body mass index of 41 kg/m2. The median time to follow-up was 2.99 years. Routine 2- and 5-year upper endoscopy was performed in 256 (55.3%) and 65 (38.0%) eligible patients, respectively. In 86 (15.1%) patients, MU was diagnosed at a median time of 14.2 months (4.58–26.2) postoperatively and 24.4% of patients with MU were asymptomatic. In total, 76.7% of MUs were located on the side of the Roux limb. 88.4% of MUs were treated conservatively; re-operation was necessary in 10 (11.6%) patients. Smoking and type 2 diabetes mellitus were the only independent risk factors for MU development in multivariate analysis with a hazard ratio of 2.65 and 1.18 (HbA1c per unit >6.0), respectively.

Conclusion

MU is a common complication after gastric bypass surgery with 25% of patients being asymptomatic. Follow-up routine endoscopy is recommended for early MU detection and subsequent accurate therapy, especially in patients with the independent risk factors smoking and type 2 diabetes mellitus.

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Acknowledgements

The authors thank Ms. P. Heeb, scientific assistant, and Ms. N. Graf, statistician, for their contribution.

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Author notes

  1. Julian Süsstrunk and Lara Wartmann contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland

    Julian Süsstrunk, Diana Mattiello, Thomas Köstler & Urs Zingg

  2. Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland

    Julian Süsstrunk

  3. Faculty of Medicine, University of Basel, 4001, Basel, Switzerland

    Lara Wartmann

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Correspondence to Julian Süsstrunk.

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Ethical Approval Statement

All procedures performed were in accordance with the ethical standards of the local research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent does not apply as this is a database analysis.

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Key Points

•Marginal ulcers are asymptomatic in up to 25%.

•MUs are a common complication after RYGB and must be excluded at a low threshold.

•Most MUs can be treated conservatively; follow-up upper endoscopy is mandatory.

•Smoking and T2DM are independent risk factors for the development of MU after RYGB.

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Süsstrunk, J., Wartmann, L., Mattiello, D. et al. Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures. OBES SURG 31, 3005–3014 (2021). https://doi.org/10.1007/s11695-021-05363-4

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  • DOI: https://doi.org/10.1007/s11695-021-05363-4

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