Gastric Bypass: Marginal Ulceration
Since its introduction, the ulcerogenic potential of the Roux-en-Y gastric bypass has been brought into question. Despite concerns stemming from the high incidence of stomal ulceration in previous gastric exclusion operations, this has not been found to be the case with Roux-en-Y gastric bypass, which excludes much of the acid-secreting mucosa, as well as the antrum. Mason et al. postulated that gastric acid secretion is under antral control in most people; therefore, gastric bypass operations decrease acid production. This was further demonstrated by Smith et al., who documented significantly decreased basal and pentagastrin-stimulated acid production in the gastric pouch.
Despite the predicted reduction in acid secretion, marginal ulceration can be a relatively troublesome complication of Roux-en-Y gastric bypass, with a historical incidence reported to be between 3% and 20%, and more recent literature reporting an incidence between 2% and 4%.
KeywordsGastric Bypass Gastric Acid Secretion Gastric Pouch Roux Limb Marginal Ulceration
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Capella JF, Capella RF. Staple disruption and marginal ulceration in gastric bypass procedures for weight loss. Obes Surg 1996;6:44-49PubMedCrossRefGoogle Scholar
Dallal RM, Bailey LA. Ulcer disease after gastric bypass. Surg Obes Relat Dis 2006;2: 455-459PubMedCrossRefGoogle Scholar
Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:460-463PubMedCrossRefGoogle Scholar
Mason EE, Munns JR, Kealey GP, et al. Effect of gastric bypass on gastric secretion. Am J Surg 1977;131:162-168CrossRefGoogle Scholar
Pope GD, Goodney PP, Burchard KW, et al. Peptic ulcer/stricture after gastric bypass: a comparison of technique and acid suppression variables. Obes Surg 2002;12:30-33PubMedCrossRefGoogle Scholar
Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the se of absorbale anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:11-16PubMedCrossRefGoogle Scholar
Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 2002;12:634-638PubMedCrossRefGoogle Scholar
Smith CD, Herkes SB, Behrns KE, et al. Gastric acid secretion and Vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity. Ann Surg 1993;1:91-96CrossRefGoogle Scholar
Wilson JA, Romagnuolo J, Byrne KT, et al. Predictors of endoscopic findings after Roux-en-Y gastric bypass. Am J Gastroenterol 2006;101:2194-2199PubMedCrossRefGoogle Scholar
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