Stomal ulcers after gastric bypass.

Introduction of gastric bypass as treatment for morbid obesity in 1966 caused over its ulcerogenic potential as an antral exclusion procedure. However, in only 20 of our 653 patients has marginal ulceration developed. Predominant symptoms were epigastric pain, occult gastrointestinal bleeding, and vomiting. Barium contrast roentgenography was as diagnostically accurate as endoscopy in these lesions. Objective measurement ensuring creation of a gastric reservoir of 50 mL maximum size reduced the incidence of marginal ulcer from 3.8% to 0.98%. Upper pouch size determined the mode of therapy. Nonoperative therapy was successful in patients with small pouches, but did not relieve symptoms of patients with large reservoirs. Truncal vagotomy and resection of redundant upper pouch was the preferred operative approach in these patients.