Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland.
Obes Surg. 2021 Jul;31(7):3005-3014. doi: 10.1007/s11695-021-05363-4. Epub 2021 Mar 24.
Marginal ulcer (MU) is a serious complication after Roux-en-Y gastric bypass (RYGB) procedures. This study reports the incidence, risk factors, and treatment outcomes of symptomatic and incidentally, at routine endoscopy diagnosed, MU.
All patients undergoing RYGB procedures between 2013 and 2018 at a single center were included. Upper endoscopy was performed in case of symptoms and/or routinely 2 and 5 years postoperatively.
In total, 568 patients (83.3% female) underwent RYGB procedure with a median age of 40 years and median initial body mass index of 41 kg/m. The median time to follow-up was 2.99 years. Routine 2- and 5-year upper endoscopy was performed in 256 (55.3%) and 65 (38.0%) eligible patients, respectively. In 86 (15.1%) patients, MU was diagnosed at a median time of 14.2 months (4.58-26.2) postoperatively and 24.4% of patients with MU were asymptomatic. In total, 76.7% of MUs were located on the side of the Roux limb. 88.4% of MUs were treated conservatively; re-operation was necessary in 10 (11.6%) patients. Smoking and type 2 diabetes mellitus were the only independent risk factors for MU development in multivariate analysis with a hazard ratio of 2.65 and 1.18 (HbA1c per unit >6.0), respectively.
MU is a common complication after gastric bypass surgery with 25% of patients being asymptomatic. Follow-up routine endoscopy is recommended for early MU detection and subsequent accurate therapy, especially in patients with the independent risk factors smoking and type 2 diabetes mellitus.
边缘性溃疡（MU）是 Roux-en-Y 胃旁路（RYGB）手术后的严重并发症。本研究报告了有症状和偶然在常规内镜诊断的 MU 的发生率、危险因素和治疗结果。
纳入 2013 年至 2018 年在单一中心接受 RYGB 手术的所有患者。出现症状时或术后 2 年和 5 年进行上消化道内镜检查。
共 568 例（83.3%为女性）接受 RYGB 手术，中位年龄为 40 岁，中位初始体重指数为 41kg/m。中位随访时间为 2.99 年。256 例（55.3%）和 65 例（38.0%）符合条件的患者分别进行了常规 2 年和 5 年的上消化道内镜检查。86 例（15.1%）患者在术后中位时间 14.2 个月（4.58-26.2）时诊断为 MU，24.4%的 MU 患者无症状。总的来说，76.7%的 MU 位于 Roux 支侧。88.4%的 MU 接受保守治疗；10 例（11.6%）患者需要再次手术。吸烟和 2 型糖尿病是多变量分析中 MU 发生的唯一独立危险因素，风险比分别为 2.65 和 1.18（HbA1c 每增加 6.0 单位）。
MU 是胃旁路手术后常见的并发症，25%的患者无症状。建议进行随访常规内镜检查，以便早期发现 MU，并随后进行准确的治疗，特别是对于有吸烟和 2 型糖尿病这两个独立危险因素的患者。
