Which Factors Correlate with Marginal Ulcer After Surgery for Obesity?
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ORIGINAL CONTRIBUTIONS
Which Factors Correlate with Marginal Ulcer After Surgery for Obesity? Duarte-Chavez Rodrigo 1
&
Stoltzfus Jill 2 & Marino Daniel 3 & Chaput Kimberly 1 & El Chaar Maher 4
Received: 23 May 2020 / Revised: 27 August 2020 / Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Marginal ulcer is one of the most common complications after Roux-en-Y gastric bypass and is defined as an ulceration of any depth at or near the gastrojejunal anastomosis. Different risk factors have been advocated to be the causative agent. Materials and Methods The weighted discharges from the Nationwide Inpatient Sample from 2003 to 2011 were used to assess for risk factors to develop marginal ulcer such as Helicobacter pylori infection, chronic nonsteroidal anti-inflammatory use, chronic aspirin use, alcohol dependence, smoking, hypertension, and diabetes mellitus type II. Results Chronic nonsteroidal anti-inflammatory drug use was the most significant risk factor for marginal ulcer, followed by Helicobacter pylori infection, obstructive sleep apnea, female sex, smoking, and alcohol dependence in decreasing order. Diabetes mellitus and hypertension were found to slightly increase the risk for marginal ulcer. The use of aspirin was found to be a minor risk factor during univariate analysis but a protective factor during multivariate analysis. Conclusions Multiple well-documented single factors are related to the genesis of a marginal ulcer, although it is likely that a combination of risk factors is responsible for this problem. These risk factors should be identified and removed or controlled. Keywords Marginal ulcer . Nonsteroidal anti-inflammatory drug . Helicobacter pylori . Obstructive sleep apnea . Nationwide Inpatient Sample
Introduction Due to the obesity epidemic that affects about 39% of the US adult population, bariatric procedures have become common given their proven long-term benefits in terms of sustained weight loss and treatment of the comorbidities associated with obesity [1–4]. In the USA, over 250,000 cases are performed annually; the majority of these cases consist of laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy * Duarte-Chavez Rodrigo [email protected]
[5–8]. The American Society for Metabolic and Bariatric Surgery has provided recommendations to categorize complications from bariatric surgery, dividing complications based on timing (early vs late) and severity (major vs minor) [9]. Marginal ulcer (MU) is one of the most common complications after RYGB, it can also happen after a single anastomosis gastric bypass although less frequently [10]. It is defined as an ulceration of any depth at or near the gastrojejunal (GJ) anastomosis [11, 12]. MU is included in the minor 1
Department of Medicine, Division of Gastroenterology, St. Luke’s University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
2
Department of Research, St. Luke’s University Health Network, 801 Ostrum Street, Beth
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