Obesity Surgery

, Volume 24, Issue 2, pp 299–309 | Cite as

Development of Ulcer Disease After Roux-en-Y Gastric Bypass, Incidence, Risk Factors, and Patient Presentation: A Systematic Review

  • Usha K. CoblijnEmail author
  • Amin B. Goucham
  • Sjoerd M. Lagarde
  • Sjoerd D. Kuiken
  • Bart A. van Wagensveld
Review Article


Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard in bariatric surgery. A long-term complication can be marginal ulceration (MU) at the gastrojejunostomy. The mechanism of development is unclear and symptoms vary. Management and prevention is a continuous subject of debate. The aim was to assess the incidence, mechanism, symptoms, and management of MU after LRYGB by means of a systematic review. Forty-one studies with a total of 16,987 patients were included, 787 (4.6 %) developed MU. The incidence of MU varied between 0.6 and 25 %. The position and size of the pouch, smoking, and nonsteroidal inflammatory drugs usage are associated with the formation of MU. In most cases, MU is adequately treated with proton pump inhibitors, sometimes reoperation is required. Laparoscopic approach is safe and effective.


Anastomotic ulcer Bariatric surgery Bleeding ulcer Gastric bypass Ischemic ulcer Marginal ulcer Morbid obesity Perforation Roux-en-Y gastric bypass RYGB Ulcer 



SM Lagarde is supported by a Koningin Wilhelmina Fonds (KWF, Dutch Cancer Society Fellowship, UVA 2013-5853). Special thanks to Mrs. H. Swindin for her knowledge and assistance.


All authors report no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Usha K. Coblijn
    • 1
    Email author
  • Amin B. Goucham
    • 1
  • Sjoerd M. Lagarde
    • 1
  • Sjoerd D. Kuiken
    • 2
  • Bart A. van Wagensveld
    • 1
  1. 1.Department of SurgerySint Lucas Andreas HospitalAmsterdamThe Netherlands
  2. 2.Department of GastroenterologySint Lucas Andreas HospitalAmsterdamThe Netherlands

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