Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Abstract

Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.

Marginal Ulcer Perforation after One Anastomosis Gastric Bypass: Surgical Treatment and Two-Year Outcomes

“…Data regarding the follow-up of patients was captured and included, such as the time from the OAGB revision to the last follow up, the last follow up BMI, %TWL, presence of symptoms suggestive of MU [ 11 ], and/or upper gastrointestinal (GI) endoscopic findings of MU. We also collected data regarding the need for an additional surgical revision during the follow up.…”

Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting

“…We encourage patients to crush medications if feasible in the early weeks after TORe. Patients must avoid tobacco and nonsteroidal anti-inflammatory drugs indefinitely due to reduced risk of marginal ulceration (30). Critically, patients should have longitudinal follow-up with a registered dietician as this support directly correlates with post-TORe success (10).…”

Navigating Bariatric Surgery: Understanding and Managing Short-Term and Long-Term Complications

“…Smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), insufficient blood flow to the anastomosis, heavy alcohol intake, and subpar surgical skills are some risk factors that increase the risk of developing marginal ulcers. Endoscopy is often used to diagnose marginal ulcers because it provides a clear view of the affected region [ 39 ]. Proton pump inhibitors (PPIs), quitting smoking, and refraining from NSAIDs and alcohol are other treatment options.…”