A. Furukawa1, D. T. Dempsey1, N. Williams1, C. Neylan1, K. Dumon1 1Hospital Of The University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction: Marginal ulcer (MU) is a known complication of Roux-en-Y gastric bypass (RYGBP) but few studies have looked at long-term incidence in this patient population. The purpose of this study is to better understand the prevalence, risk factors, complications, and cost of symptomatic MU in RYGBP patients in patients followed >2.5 years.
Methods: With IRB approval, all patients having RYGBP at our institution from 2003-2012 were reviewed. All patients who developed symptomatic marginal ulcers were analyzed (MU group=166). A randomly selected cohort of RYGBP patients without MU were selected and analyzed for comparison (non MU group=150) Charts were retrospectively reviewed for ulcer risk factors, ulcer complications, and charges (hospital and physician). Here, postoperative upper endoscopy (EGD) was used as a surrogate for utilization of healthcare resources. All statistical analysis including multivariate regression was performed Stata/IC 14.
Results: Over a 10 year span, there were 2,019 patients who underwent RYGBP. 166 developed MU (8% incidence of MU). Of those 166 patients, 135 (81%) were conservatively managed with medication and 31 (19%) needed ulcer operation. Of these 31 patients, 19 had emergent operations due to perforation and 12 had elective operations. Men were more likely to need emergency operation (p<0.05). On multivariate analysis, smoking and diabetes significantly increased the risk of MU (p<0.05), but hypertension, GERD, male gender, increased age, or increasing BMI did not. MU patients had a total of 437 EGDs after RYGBP, significantly more than patients without marginal ulcers who had a total of 41 (p<.001).
Conclusion: Symptomatic MU is common after RYGBP and leads to increased utilization of healthcare resources. Though smoking cessation is already recommended, increased MU incidence in smokers highlights the importance of adherence in RYGBP patients. To our knowledge, the relationship between MU and diabetes has not been looked at. Long term acid suppression after RYGBP should be considered, especially in men, diabetics, and in patients with smoking history.
