Abstract
PurposeMarginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastric bypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MU between DS and RYGBP in a well-defined cohort and to identify associative factors.MethodsA cohort of 732 patients with BMI ≥ 48 who had undergone primary DS or RYGBP during 2008–2018 received a questionnaire concerning ulcers, PPI therapy, and smoking habits; hereafter, patient charts were reviewed. Incidence rates (IRs) for MU were calculated in our survey and on previous registered data in the national quality register for bariatric surgery (SOReg). A multivariate regression analysis was performed to identify predictive risk factors for MU.ResultsAfter a mean follow-up of 6.1 years, 472 (64%) patients responded (47 ± 11 years old, 65% women and 42% DS). Of 41 MUs identified, 23 were endoscopically verified. Gastrointestinal bleeding, abdominal pain, and dysphagia were the most common symptoms. IR for MU was 1.4% (DS 1.3% and RYGBP 1.5%) per patient-year, compared with 0.9% according to SOReg-data. Persisting PPI treatment was seen in about three quarter of former MU patients (OR 11.2 [3.6–34.7], p < 0.001), but no other associative factors were found.ConclusionThe overall risk for MU was low, about 1% per patient-year, without difference between DS and RYGBP. Ongoing PPI treatment was frequent in many former MU patients. This study on MU after DS provides reassuring results for future bariatric surgery candidates.
Highlights
Severe obesity is associated with increased mortality and morbidity [1, 2]
We thoroughly reviewed the patient charts, and when we were not clear about any response, we telephoned the patient to ensure clarity
Because of the varying duration from surgery, the incidence rate (IR) of marginal ulcer (MU) was determined after calculating years at risk
Summary
Severe obesity is associated with increased mortality and morbidity [1, 2]. Gastric bypass (RYGBP) is well-established worldwide [5] and often considered as gold standard. The pathophysiology is multifactorial, and factors like high acidity, for example, due to large pouch size or gastro-gastric fistula, Helicobacter pylori; local ischemia; and remaining foreign bodies from staple material as well as the used staple technique in itself have been mentioned in many studies [11,12,13,14,15,16,17,18]. Several patientrelated factors such as smoking, use of corticosteroids and NSAIDs, and various obesity-related comorbidities have been described [12, 15].
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