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Marginal Ulcers Following One-Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis

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Abstract

Background

Marginal ulcer (MU) is an uncommon but significant complication following one-anastomosis gastric bypass (OAGB). Our study aims to understand the incidence rates, risk factors, and management of MU following OAGB.

Methods

MEDLINE, Scopus, and Cochrane Library databases were examined to identify all studies on OAGB where authors had reported on MU. Data were collected on basic demographics, incidence rates, risk factors, and management of this condition.

Results

Thirty-two studies involving 8868 patients were analysed. The mean age and body mass index (BMI) of patients in these studies were 40.9 ± 4.5 years and 47.6 ± 5.6 kg/m2, respectively. Among the patient cohort, approximately 72% were female, and 20.6% had preoperative gastroesophageal reflux disease (GERD). The authors described prescribing proton-pump inhibitors (PPI) prophylaxis to 14.1% of patients after surgery. Two hundred twenty-eight patients were reported to have MU. The incidence of MU was 2.59% (95% CI 1.89–3.52), of which 53 patients presented within 12 months, 24 patients presented after 31 months, and five patients after 6 years. One hundred forty-six patients did not have presentation time documented. Sixty-five patients were described to have MU diagnosed on endoscopy, of which 54 were symptomatic and 11 were asymptomatic. The authors were, however, not specific on the choice of investigation for the remaining 163 patients. Of patients, 89.7% were treated conservatively with PPIs, whilst 10.3% had surgery to treat MU.

Conclusions

Marginal ulcer is an uncommon complication following OAGB. The majority of patients are treated conservatively with PPIs. Larger, well-designed studies reporting on risk factors, investigation, and management of MU following OAGB are warranted.

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Acknowledgements

The authors thank Hugh Hanchard for helping with the initial literature search.

Author information

Authors and Affiliations

  1. Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK

    Shiela Lee & Kamal Mahawar

  2. Northumbria NHS Foundation Trust, Newcastle upon Tyne, NE27 0QJ, UK

    Shreyas Supparamaniam

  3. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Chris Varghese

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  1. Shiela Lee
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  4. Kamal Mahawar
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Contributions

Study conceptualisation: K.M., S.L., S.S.

Data analysis: S.L., C.V.

Writing the manuscript and approving the finalised manuscript: S.L., S.S., C.V., K.M.

Corresponding author

Correspondence to Shiela Lee.

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Ethical Approval

Formal consent is not required for this type of study.

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The authors declare no competing interests.

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Key Points

• The overall estimated incidence of MU after OAGB was 2.59%.

• Approximately 65% of patients presented within the first 12 months after surgery.

• The majority of patients (89.7%) are treated conservatively with PPIs.

Appendix Search strategy

Appendix Search strategy

Ovid MEDLINE(R) ALL <1946 to August 10, 2022>

1

exp *Peptic Ulcer/

61,705

2

(marginal ulcer or marginal ulceration or marginal ulcers).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

490

3

stomal ulceration.mp.

39

4

(stomal ulcers or stomal ulcer).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

156

5

2 or 3 or 4

671

6

(gastric adj bypass).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

16,341

7

(bariatric adj bypass).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

26

8

exp *Gastric Bypass/

9793

9

6 or 7 or 8

16,354

10

5 and 9

308

11

10

308

12

limit 11 to (English language and humans and yr=“2015–Current”)

128

13

proton pump inhibitor.mp. or exp *Proton Pump Inhibitors/

17,160

14

proton pump inhibitors.mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

17,792

15

13 or 14

24,634

16

9 and 15

149

17

prophylaxis.mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

12,0005

18

prophylactic.mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

87,767

19

17 or 18

19,1174

20

16 and 19

17

21

10

308

22

limit 21 to (human and English language and exclude medline journals and yr=“2019–Current”)

65

23

20 not 10

4

24

23

4

25

limit 24 to (English language and exclude medline journals)

4

26

incidence.mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

97,3337

27

9 and 26

1487

28

(ulcer or ulcers or ulceration).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

21,0204

29

27 and 28

137

30

29 not 10

45

31

30

45

32

limit 31 to (English language and humans and yr=“2019–Current”)

6

33

9 and 15 and 19 and 28

15

34

33 not 30

15

35

33 not 20

0

Scopus

“mason’s loop” OR “mini-gastric bypass” OR “mini-gastric bypass” OR “single anastomosis gastric bypass” OR “single-anastomosis gastric bypass” OR “single anastomosis (mini-) gastric bypass” OR “one anastomosis (mini-) gastric bypass” OR “one anastomosis gastric bypass” OR “one-anastomosis gastric bypass” OR “omega gastric bypass” OR “omega-loop bypass” OR “omega loop bypass” AND “Peptic ulcer disease” OR “marginal ulceration” OR “anastomotic ulcer” OR “ischemic ulcer” OR “ulcers” OR “ulcera*”

Cochrane

mason’s loop OR mini-gastric bypass OR mini-gastric bypass OR single anastomosis gastric bypass OR single-anastomosis gastric bypass OR single anastomosis (mini-) gastric bypass OR one anastomosis (mini-) gastric bypass OR one anastomosis gastric bypass OR one-anastomosis gastric bypass OR omega gastric bypass OR omega-loop bypass OR omega loop bypass in Title Abstract Keyword AND Peptic ulcer disease OR marginal ulceration OR anastomotic ulcer OR ischemic ulcer OR ulcers OR ulcera* in Title Abstract Keyword

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Lee, S., Supparamaniam, S., Varghese, C. et al. Marginal Ulcers Following One-Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis. OBES SURG 33, 2884–2897 (2023). https://doi.org/10.1007/s11695-023-06762-5

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