van Hogezand Lilian L, Schropp Ludo, Verdonk Robert C, Wiezer Marinus J, Wijffels Niels A T, Takkenberg Marijn, Te Riele Wouter W, van Santvoort Hjalmar C, Derksen Wouter J M
Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands.
Department of Gastroenterology, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands.
Obes Surg. 2025 Jan;35(1):40-46. doi: 10.1007/s11695-024-07407-x. Epub 2024 Oct 29.
It is unknown what the incidence of gastroscopy-diagnosed marginal ulceration is, while gastroscopy is a frequently chosen diagnostic modality in patients presenting with abdominal pain with a Roux-en-Y gastric bypass (RYGB) in history. The aim of this study was to examine the incidence and treatment of gastroscopy-diagnosed marginal ulceration in patients presenting with the first episode of abdominal pain after RYGB, in which gastroscopy is chosen as the first step in the diagnostic work-up.
A post hoc analysis was performed of a prospective cohort of 2273 patients undergoing RYGB between 2014 and 2019 in a large non-academic hospital with a dedicated bariatric unit. All patients presenting with abdominal pain > 30 days postoperatively were included. Primary outcome was gastroscopy identified marginal ulceration and treatment.
One hundred two out of 498 patients presenting with abdominal pain after RYGB (20%) underwent gastroscopy as the first diagnostic step. In 84% of these patients, no marginal ulcer was found. Marginal ulceration was observed in 16/102 patients (16%). All patients underwent optimization of PPI treatment and lifestyle advises. Seven patients underwent revisional surgery, at a median of 163 days (range 80-1287) after diagnosis.
In a minority of patients undergoing gastroscopy for abdominal pain post-RYGB, a marginal ulceration is identified. Revisional surgery is rarely needed in all patients undergoing gastroscopy and only performed after several months when complaints persist despite PPI optimization. Only performing gastroscopy when symptoms persist safely reduces the number of gastroscopy for abdominal pain after RYGB.
在有Roux-en-Y胃旁路术（RYGB）病史且出现腹痛的患者中，胃镜检查是常用的诊断方式，但目前尚不清楚胃镜诊断的边缘性溃疡的发生率。本研究的目的是检查在RYGB术后首次出现腹痛且选择胃镜作为诊断检查第一步的患者中，胃镜诊断的边缘性溃疡的发生率及治疗情况。
对2014年至2019年期间在一家设有专门减肥科的大型非学术医院接受RYGB手术的2273例患者的前瞻性队列进行事后分析。纳入所有术后腹痛超过30天的患者。主要结局是胃镜检查发现的边缘性溃疡及治疗情况。
498例RYGB术后出现腹痛的患者中，102例（20%）作为首个诊断步骤接受了胃镜检查。其中84%的患者未发现边缘性溃疡。102例患者中有16例（16%）观察到边缘性溃疡。所有患者均接受了质子泵抑制剂（PPI）治疗优化及生活方式建议。7例患者接受了翻修手术，诊断后中位时间为163天（范围80 - 1287天）。
在少数因RYGB术后腹痛接受胃镜检查的患者中，发现了边缘性溃疡。在所有接受胃镜检查的患者中，很少需要进行翻修手术，且仅在PPI优化后症状仍持续数月时才进行。仅在症状持续时进行胃镜检查可安全减少RYGB术后腹痛的胃镜检查次数。
