Efficacy of Staple Removal in Healing Anastomotic Ulcers and Stenoses

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Purpose: Anastomotic ulcers are frequent complications of gastric bypass surgery resulting in bleeding, pain, delayed emptying or strictures. Often they are self-limiting and heal with medical management. At times they become chronic and/or recurrent. Anastomoses in other areas may also become involved with chronic inflammation. These include esophagogastrostomies, ileocolonic anastomoses and colo-colon anastomoses. This study followed the success of removing staples to heal and reduce recurrence of these ulcers. Methods: 50 patients were seen for anastomotic ulcers. 36 had gastric bypass, 4 had ileocolonic anastomotic ulcers, 4 had ulcers at the esophagogastrostomy and 6 had colocolonic anastomotic ulcers. All patients with endoscopically documented persistent or recurrent ulcers with staples present along the anastomotic line where eligible to participate. Patients whom had surgery for inflammatory bowel disease were excluded. After determining the patients had a persistent or recurrent ulcer, each patient underwent an endoscopic procedure to remove the staples. A microvasive forceps was used in each case. Dilation and/or endoincision were carried out if a stricture was seen. A follow-up examination was performed 3-4 months later. Primary endpoint of the study was ulcer healing. The secondary endpoint was prevention of restenosis. Results: Of the 36 patients with ulcers following bypass surgery, 15 had strictures in addition to their ulcer. After removing the suture and performing dilation and/or endoincision to open the stricture, only 1 had persistent stenosis at the follow-up exam. This resolved after endoincision. None of the 36 patients had ulceration at their follow-up exam. All of the ulcers seen at the esophagogastric, colonic and ileocolonic anastomoses had resolved at the follow-up examination. The patients were then followed-up for a mean time of 20 months (range 6-60 months) for signs or symptoms of recurrence. All were asymptomatic. Conclusion: 1. Removal of staples at the anastomoses allows healing and prevents recurrence of ulcerations, satisfying the primary endpoint. 2. The secondary endpoint of the study, prevention of restenosis, was also achieved.