Salame Marita, Jawhar Noura, Belluzzi Amanda, Al-Kordi Mohammad, Storm Andrew C, Abu Dayyeh Barham K, Ghanem Omar M
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
J Clin Med. 2023 Jun 28;12(13):4336. doi: 10.3390/jcm12134336.
Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.
边缘性溃疡（MU）是Roux-en-Y胃旁路术（RYGB）后的一种潜在并发症，平均发生率为4.6%。早期识别和及时干预对于减轻进一步的并发症至关重要。MU的病理生理学很复杂，涉及多种因素，包括吸烟、感染、使用非甾体抗炎药（NSAID）以及胃囊较大。MU患者可能会经历急性或慢性腹痛。极少数情况下，他们可能会出现溃疡并发症，如出血、穿孔或狭窄。在内镜检查确诊后，MU的治疗通常包括改变危险因素以及以质子泵抑制剂为主的药物治疗。对于复杂性溃疡，通常需要手术干预来修复穿孔或切除狭窄。对于复发性或顽固性溃疡，可考虑对溃疡床进行内镜覆盖、切除吻合口以及进行腹部或胸腔镜下迷走神经干切断术。本综述旨在概述RYGB术后MU的病因、诊断和治疗。
