Predictors of Endoscopic Findings after Roux-en-Y Gastric Bypass for Obesity

Abstract

Purpose: To evaluate the spectrum and predictors of endoscopic findings in symptomatic patients after Roux-en-Y Gastric Bypass (RYGBP). Methods: Retrospective chart review of 226 patients referred for upper endoscopy following RYGBP surgery performed by one surgeon at the Medical University of South Carolina from January 1993 to January 2005. Multiple logistic regression analysis was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI) for predictors of normal endoscopy, marginal ulcers, stomal stenosis, and staple-line dehiscence. Results: The most common endoscopic findings were: 99 (44%) normal post-surgical anatomy, 81 (36%) marginal ulcer, 29 (13%) stomal stenosis, and 8 (4%) staple-line dehiscence. Factors that significantly increase the risk of marginal ulcers following RYGBP surgery include smoking (AOR = 41.5; 95% CI [11 to 159]) and NSAID use (AOR = 11.2; [5.3 to 24]). A significant interaction term suggested that the risks of NSAID use and smoking together were less than additive. PPI therapy following surgery was protective against marginal ulcers (AOR = 0.32; [0.13 to 0.86]). There were non-significant trends towards nausea/vomiting predicting stenosis, and smoking increasing the risk of dehiscence (both p = 0.06). The other exposures were not predictive for marginal ulcers, stomal stenosis, or staple-line dehiscence. Mean time to diagnosis for marginal ulcers following surgery was 6.9 months, 77 of 81 (95%) presented within 12 months. Stenosis tended to present earlier at a mean of 3.4 months, and dehiscence later at a mean of 28 months. Trends regarding time to presentation, because of overlap, were not significantly predictive of findings at endoscopy. Conclusions: Following RYGBP surgery for obesity, smoking and NSAID use significantly increase the risk of marginal ulceration, and PPI therapy is protective but does not eliminate this increased risk. Because a significant majority of marginal ulcers present within 12 months of surgery, prophylactic PPI therapy should be considered during this time period, especially for high risk patients (i.e. smokers and/or NSAID users).