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Marginal ulcer continues to be a major source of morbidity over time following gastric bypass

Abstract

Background

Marginal ulcerations (MU) are a common and concerning complication following Roux-en-Y gastric bypass (RYGB) surgery. The aim of the present study was to examine the progression of MU and identify risk factors for the need for surgical intervention in patients with MU following RYGB.

Methods

A New York state longitudinal administrative database was queried to identify patients who underwent RYGB between 2005 and 2010 and who were followed for at least 4 years for the development of MU using ICD-9 and CPT codes. Patients with perforation as their first presentation of MU were excluded. Multivariable Cox proportional hazard model was built to identify risk factors for surgical intervention. Hazard ratios (HR) with 95% confidence intervals (CI) were reported.

Results

We identified 35,075 patients who underwent RYGB. Mean age was 42.47 ± 10.90 years and most were female (81.08%). There were 2201 (6.28%) patients with MU, of which 204 (9.27% of MU; 0.58% of RYGB overall) required surgery. The estimated cumulative incidence of having surgical intervention 1, 2, 5, and 8 years after MU diagnosis was 6% (95% CI 5–7%), 8% (95% CI 7–9%), 13% (95% CI 11–14%), and 17% (95% CI 13–20%), respectively. At time of MU diagnosis, younger age (HR 0.93 every 5 years, 95% CI 0.87–0.99), white race (HR 1.60, 95% CI 1.15–2.23), and weight loss (HR 2.82, 95% CI 1.62–4.88) were independent risk factors for subsequent surgical intervention for MU. Estimated cumulative incidence of MU recurrence was 15% (95% CI 9–22%) and 24% (95 CI% 15–32%) at 6 and 12 months after surgical intervention.

Conclusions

The need for surgical intervention for MU after RYGB is uncommon. Young age, white race, and marked weight loss are risk factors for surgical intervention. Such patients may benefit from early intensive medical therapy at the time of MU diagnosis.

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Acknowledgements

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

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Correspondence to Konstantinos Spaniolas.

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Disclosures

Dr. Aurora Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore, and is a consultant for Medicines Company, Merck, Intuitive, BAROnova, Obalon Therapeutics. Dr. Pryor also has ownership interest in Transenterix. Dr. Konstantinos Spaniolas is on the advisory board for Mallincktodt and received a research grant from Merck. Donglei Yin, Drs. Owen Pyke, Jie Yang, Tyler Cohn, Salvatore Docimo, Andrew Bates, and Mark Talamini have no conflicts of interest or financial ties to disclose.

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Pyke, O., Yang, J., Cohn, T. et al. Marginal ulcer continues to be a major source of morbidity over time following gastric bypass. Surg Endosc 33, 3451–3456 (2019). https://doi.org/10.1007/s00464-018-06618-5

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Keywords

  • Marginal ulcer
  • Gastric bypass
  • Anastomotic ulcer