Obesity Surgery

, Volume 27, Issue 5, pp 1394–1396 | Cite as

Endoscopic Suturing for Massively Bleeding Marginal Ulcer 10 days Post Roux-en-Y Gastric Bypass

  • Sindhu Barola
  • Thomas Magnuson
  • Michael Schweitzer
  • Yen-I Chen
  • Saowanee Ngamruengphong
  • Mouen A Khashab
  • Vivek KumbhariEmail author
Video Submission



Marginal ulceration post Roux-en-Y gastric bypass (RYGB) with associated bleeding, although infrequently encountered, can be challenging to treat. Flexible endoscopic therapy is preferred over surgery due to its minimally invasive nature. Bleeding ulcers have traditionally been treated endoscopically by injecting epinephrine, bipolar hemostasis, or clips. Here, we describe our treatment with endoscopic suturing for a massively bleeding marginal ulcer after RYGB.


A 56-year-old female 10 days post RYGB underwent her fourth endoscopy for investigation and management of hematemesis and was found to have a large bleeding anastomotic ulcer. A Rothnet was utilized to remove large blood clots which obstructed endoscopic visualization. Two marginal ulcers were noted, and these were successfully oversewn with endoscopic suturing. The multimedia video (7 min) demonstrates the management of massively bleeding marginal ulcer after RYGB by endoscopic suturing.


Patient had no further bleeding and tolerated diet the subsequent day. She was discharged home with no further episodes of hematemesis, and follow-up at 6 weeks showed well-healed ulcer on endoscopy.


Endoscopic suturing of a bleeding marginal ulcer appears technically feasible and safe. It should be considered in the treatment algorithm prior to emergency surgery.


Roux-en-Y gastric bypass Hematemesis Epinephrine Endoscopic suturing Marginal ulcer 



Roux-en-Y gastric bypass




Authors’ Contributions

The authors were involved in the writing of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

Mouen A. Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical.

Vivek Kumbhari is a consultant for Boston Scientific and Apollo Endosurgery.

All other authors have no disclosures.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained by all individual participants included in the study.

Full verbal and written informed consent has been obtained from the patients for submission of this manuscript for publication.

Funding Sources or Institutional or Corporate Affiliations


Supplementary material


(MP4 358,923 kb).


  1. 1.
    Sapala JA, Wood MH, Sapala MA, et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8:505–16.CrossRefPubMedGoogle Scholar
  2. 2.
    Garrido AB, Rossi M, Lima SE, et al. Early marginal ulcer following roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study. Arq Gastroenterol. 2010;47:130–4.CrossRefGoogle Scholar
  3. 3.
    Wilson JA, Romagnuolo J, Byrne TK, et al. Predictors of endoscopic findings after roux-en-Y gastric bypass. Am J Gastroenterol. 2006;101:2194–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Kalaiselvan R. G Exarchos, Hamza N, et al incidence of perforated gastrojejunal anastomotic ulcers after laparoscopic gastric bypass for morbid obesity and role of laparoscopy in their management. Surg Obes Relat Dis. 2012;8(4):423–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Kumar N, Thompson CC. Endoscopic management of complications after gastrointestinal weight loss surgery. Clin Gastroenterol Hepatol. 2013;11:343–53.CrossRefPubMedGoogle Scholar
  6. 6.
    Nayantara Coelho Prabhu MBBS, Louis MW, Kee Song MD. Achieving hemostasis and the risks associated with therapy. Gastrointest Endosc Clin N Am. 2015;25(1):123–45. doi: 10.1016/j.giec.2014.09.012.CrossRefPubMedGoogle Scholar
  7. 7.
    Campos JM, Moon R, Teixeira A, et al. Endoscopic Management of Massive Hemorrhage 12 h post laparoscopic roux-en-Y gastric bypass. Obes Surg. 2015;25:1981–3. doi: 10.1007/s11695-015-1812-6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Sindhu Barola
    • 1
    • 2
  • Thomas Magnuson
    • 2
    • 3
  • Michael Schweitzer
    • 2
    • 3
  • Yen-I Chen
    • 1
    • 2
  • Saowanee Ngamruengphong
    • 1
    • 2
  • Mouen A Khashab
    • 1
    • 2
  • Vivek Kumbhari
    • 1
    • 2
    Email author
  1. 1.Department of Medicine and Division of Gastroenterology and HepatologyThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Department of MedicineThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Department of SurgeryThe Johns Hopkins Medical InstitutionsBaltimoreUSA

Personalised recommendations