Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients
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ORIGINAL CONTRIBUTIONS
Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients Zakaria Bekhali 1,2
&
Magnus Sundbom 1
Received: 4 May 2020 / Revised: 23 June 2020 / Accepted: 23 June 2020 # The Author(s) 2020
Abstract Purpose Marginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastric bypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MU between DS and RYGBP in a well-defined cohort and to identify associative factors. Methods A cohort of 732 patients with BMI ≥ 48 who had undergone primary DS or RYGBP during 2008–2018 received a questionnaire concerning ulcers, PPI therapy, and smoking habits; hereafter, patient charts were reviewed. Incidence rates (IRs) for MU were calculated in our survey and on previous registered data in the national quality register for bariatric surgery (SOReg). A multivariate regression analysis was performed to identify predictive risk factors for MU. Results After a mean follow-up of 6.1 years, 472 (64%) patients responded (47 ± 11 years old, 65% women and 42% DS). Of 41 MUs identified, 23 were endoscopically verified. Gastrointestinal bleeding, abdominal pain, and dysphagia were the most common symptoms. IR for MU was 1.4% (DS 1.3% and RYGBP 1.5%) per patient-year, compared with 0.9% according to SOReg-data. Persisting PPI treatment was seen in about three quarter of former MU patients (OR 11.2 [3.6–34.7], p < 0.001), but no other associative factors were found. Conclusion The overall risk for MU was low, about 1% per patient-year, without difference between DS and RYGBP. Ongoing PPI treatment was frequent in many former MU patients. This study on MU after DS provides reassuring results for future bariatric surgery candidates. Keywords Bariatric surgery . Complications . Duodenal switch . Gastric bypass . Marginal ulcer . Incidence rate . Long term
Introduction Severe obesity is associated with increased mortality and morbidity [1, 2]. Surgical treatment results in sustainable weight loss, reduced comorbidity, and improvement of quality of life [3, 4]. Among several bariatric procedures, gastric bypass (RYGBP) is well-established worldwide [5] and often considered as gold standard. Duodenal switch (DS) usually Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04822-8) contains supplementary material, which is available to authorized users. * Zakaria Bekhali [email protected] 1
Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
2
Department of Surgery, Gävle Hospital, Kirurgmottagningen, Gävle sjukhus, SE-801 88 Gävle, Sweden
performed on patients with higher BMI (BMI > 50) results in more sustainable weight loss [6, 7] but is less frequently performed due to increased technical demands and risk for metabolic complications in the long term [8–10]. Despite the benefits in bariatric and metabolic surgery, o
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