Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis

Beran, Azizullah; Shaear, Mohammad; Al-Mudares, Saif; Sharma, Ishna; Matar, Reem; Al‐Haddad, Mohammad; Salame, Marita; Portela, Ray; Clapp, Benjamin; Dayyeh, Barham K. Abu; Ghanem, Omar M.

doi:10.1007/s11605-023-05619-7

Cited by 27 publications

(17 citation statements)

References 39 publications

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“…Studies have shown that Helicobacter pylori infection, smoking, use of nonsteroidal anti-inflammatory drugs, diabetes mellitus, immunosuppression, and larger pouch size are predictors for marginal ulceration after RYGB. 53,54 Use of proton pump inhibitors is the only protection from marginal ulcer formation, and bariatric surgeons typically prescribe this medication postoperatively for 1-6 months. Another serious long-term complication after RYGB is an internal hernia.…”

Section: Roux-en-y Gastric Bypassmentioning

confidence: 99%

Updates in Bariatric Surgery

Hsu,

Farrell

2023

The American Surgeon™

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Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.

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Section: Roux-en-y Gastric Bypassmentioning

confidence: 99%

Updates in Bariatric Surgery

Hsu,

Farrell

2023

The American Surgeon™

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“…It is believed that the bacteria could potentially create a state of chronic inflammation accompanied by gastritis and metaplasia, ultimately resulting in the formation of MU [ 40 ]. While some studies report no association between H. pylori infection and the occurrence of MU [ 41 , 42 ], more solid data reveals a substantial correlation between the presence of the bacteria and MU [ 11 , 43 , 44 ]. This was further corroborated by Beran et al, who identified H. pylori infection as the most significant predictor for MU [ 11 ].…”

Section: Physiopathology and Predictorsmentioning

confidence: 99%

“…While some studies report no association between H. pylori infection and the occurrence of MU [ 41 , 42 ], more solid data reveals a substantial correlation between the presence of the bacteria and MU [ 11 , 43 , 44 ]. This was further corroborated by Beran et al, who identified H. pylori infection as the most significant predictor for MU [ 11 ].…”

Section: Physiopathology and Predictorsmentioning

confidence: 99%

“…MU is a potential complication following RYGB, which typically occurs at or near the gastrojejunal anastomosis, with a reported mean incidence rate of 4.6% [ 8 , 9 , 10 ]. While the pathophysiology of MU remains unclear, there are several potential risk factors that have been identified, including smoking, diabetes, use of nonsteroidal anti-inflammatory drugs (NSAID), Helicobacter pylori infection, and alcohol consumption, among others [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Symptoms of MU can vary, with some patients being asymptomatic while others present with nausea/vomiting, abdominal pain, or gastrointestinal (GI) bleeding, potentially explaining the variability in the reported incidence rates [ 8 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Salame,

Jawhar,

Belluzzi

et al. 2023

JCM

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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.

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“…Marginal ulceration at the gastrojejunostomy is another late complication of gastric bypass that commonly requires emergent surgical intervention. 62,63 This is typically only seen after gastric bypass and not with other bariatric procedures. The incidence is 2% to 15% and varies by anastomotic techniques and patient populations.…”

Section: Late Complications (>30 Postoperative Days): Internal Hernia...mentioning

confidence: 99%

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

Cheng,

Samakar,

Dobrowolsky

et al. 2023

J Trauma Acute Care Surg

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The field of bariatric and metabolic surgery has changed rapidly over the past two decades, with an exponential increase in case volumes being performed because of its proven efficacy for morbid obesity and obesity-related comorbidities. Although this increased volume of procedures has been accompanied by significant decrease in postoperative complication rates, there are numerous potential complications after bariatric surgery that may require urgent or emergent surgical evaluation or interventions. Many of these risks extend well beyond the early postoperative period and can present months to years after the index procedure. Acute care surgeons are increasingly covering most or all of the emergency general surgery services at many centers and must be familiar with the numerous bariatric surgical procedures being performed and their individual complication profile to provide optimal care for these frequently challenging patients. This article provides a focused and concise review of the common bariatric procedures being performed, their early and late complication profiles, and a practical guide to the optimal diagnostic evaluations, surgical interventions, and perioperative management options. The author group includes both acute care surgeons and bariatric surgeons with significant experience in the emergency management of the complicated postbariatric surgical patient. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.

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Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis

Cited by 27 publications

References 39 publications

Updates in Bariatric Surgery

Updates in Bariatric Surgery

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

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

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