Management of Acute Gastric Remnant Complications After Roux-en-Y Gastric Bypass: a Single-Center Case Series

Gastric Remnant Perforation after Roux-en-Y Gastric Bypass: A Case Report and Literature Review

“…These complications have been described as late as 20 years after RYGBP, so the long-term follow-up is important in these patients. 1,2 Risk factors for perforation of the gastric remnant are almost the same as those for marginal gastrojejunal ulcers. Mucosal ulcerations may be caused by excessive alcohol consumption, smoking, or nonsteroidal anti-inflammatory drug intake.…”

“…In case of gastric cancer confirmation, treatment does not differ from management in patients with prior partial gastrectomy:gastric remnant gastrectomy with D2 lymphadenectomy. 2 To access the bypassed gastroduodenal segment, upper endoscopy is useless, so different modalities have been described. It is possible to address directly to the excluded stomach with a percutaneous approach guided by ultrasound or CT.…”

Ulcer Disease in the Excluded Segments after Roux-en-Y Gastric Bypass: a Current Review of the Literature

“…Thus, other factors might have a higher impact on ulcer formation. [11] 0/2 36 3 n/a Y n/a 54 0.2 n/a n/a n/a Bjorkman [12] 0/1 24 6 n/a N n/a Braley [13] 2/1 49 17 n/a n/a n/a 59 17 n/a n/a n/a 49 16 n/a n/a n/a Dai [9] 1 / 0 5 4 5 N N n e g Eid [14] 0/1 61 10 N N n/a Gypen [15] 1/0 35 0.2 n/a n/a pos Husain [16] 1/0 63 1.5 n/a n/a n/a Iranmannesh [28] 4 [24] 0/1 48 4 n/a n/a n/a Zagzag [27] 5/0 57 5 n/a n/a pos 54 12 n/a n/a pos 53 9 n/a n/a neg 47 0.7 n/a n/a n/a…”

“…Eleven (20%) of the reported patients underwent a standard upper endoscopy, which was non-diagnostic in every case. In 5 patients, retrograde endoscopy was attempted; the remnant was reached in three patients, and treatment of the bleeding was successful in two patients [12,14,22,28]. Thus, in time-critical situations, conventional upper endoscopy can rule out pathologies of the gastric pouch, anastomosis, and alimentary limb, but its diagnostic value in assessing the excluded segments is limited.…”

“…Usually, access to the gastric remnant is established during laparoscopy via temporary remnant gastrostomy [72]. Among the reviewed patients with ulcer bleeding or perforation after RYGB, 8 of 54 had (15%) intraoperative transgastric endoscopy [13,18,25,28]. Endoscopy revealed duodenal ulcers in 3 cases and gastritis and benign ulcers in 2 cases.…”