Gastric Bypass pp 247-253 | Cite as

Marginal Ulceration After (Laparoscopic) Roux-en-Y Gastric Bypass: Pathophysiology, Diagnostics, Treatment, and Prevention

  • U. K. Coblijn
  • B. A. van Wagensveld
  • S. M. Lagarde
  • S. M. M. de Castro


Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most performed bariatric procedures worldwide. One of the long-term complications is a marginal ulcer (MU). This is a potentially severe complication which can lead to massive bleeding or perforation. The pathophysiology is still unclear but most likely multifactorial and due to exposure of the jejunum to gastric acid, corpora aliena, and tension at the anastomosis. Most patients suffer from epigastric burn or abdominal pain, but a significant portion does not have any symptoms at all, possibly increasing the risk of a pouch perforation or bleeding. Around two thirds of the patients with MU can be sufficiently treated with proton pump inhibitors (PPIs), whereas patients who suffer from a perforation or bleeding are more likely to need endoscopy or even surgery as treatment. The development of MU can be prevented with a prophylactic course of PPIs.


Anastomotic ulcer Bariatric surgery Bleeding ulcer Gastric acid Gastric bypass Marginal ulcer Morbid obesity Perforation Roux-en-Y gastric bypass PPIs 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • U. K. Coblijn
    • 1
  • B. A. van Wagensveld
    • 2
  • S. M. Lagarde
    • 3
  • S. M. M. de Castro
    • 2
  1. 1.Department of SurgeryVrije Universiteit Medical CenterAmsterdamThe Netherlands
  2. 2.Department of SurgeryOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  3. 3.Department of SurgeryErasmus Medical CenterRotterdamThe Netherlands

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