Rodrigo Duarte-Chavez, MD1, Noel B. Martins, MD1, Kimberly J. Chaput, DO1, Sagar V. Mehta, MD2, Maher El Chaar, MD3
1St. Luke's University Health Network, Bethlehem, PA; 2St. Luke's University Hospital, Bethlehem, PA; 3St. Luke's University Health Network, Allentown, PA
Introduction: The obesity epidemic affects more than one-third of the USA adult population, and over 350 000 bariatric procedures are performed annually. While bariatric surgery results in long lasting weight loss and resolution of comorbidities, complications can occur after surgery. Marginal ulceration (MU) is the most common complication following Roux-en-Y gastric bypass (RYGB), with an incidence reported to be between 1-9%.
The etiology of MU is largely unknown but is believed to be secondary to technical aspects of the surgery as well as local factors such as inflammation and underlying macro and microvascular damage.The objective of this study is to investigate non-surgical factors and comorbidities that may contribute to the incidence of MU based on a national database.
Methods: After Institutional Review Board exemption was granted, we retrospectively reviewed the National Inpatient Sample database from 2003 to 2011. ICD-9 codes were used to abstract data including RYGB for obesity, gastrojejunal (GJ) ulcer, Helicobacter pylori infection (HPI), use of NSAIDs, use of aspirin, diabetes, hypertension, obstructive sleep apnea (OSA) and smoking. We compared groups using chi-squared and unadjusted odds ratio (OR). Multivariate logistic regression analysis was performed to adjust for confounders
Results: 34830 patients with GJ ulcer after RYGB for obesity were identified. In univariate analysis, OSA had the highest OR of all the variables (91.22), whereas aspirin use had the lowest (3.09). All the listed factors were associated with increased risk for MU (Table 1). During multivariate analysis, NSAID use had the highest OR (13.14) followed by HPI (5.08) and OSA (4.03). Aspirin use was not found to be associated with the development of MU in our multivariate analysis (Table 2).
Discussion: To our knowledge this is the largest study assessing the risk factors for MU after RYGB for obesity and the first to report that OSA strongly correlates with the presence of MU. Our analysis demonstrated that the most significant risk factors for development of MU were in decreasing order NSAID, HPI, OSA and Smoking.
Studies using bariatric specific databases should examine the issue. Prospective studies are also required to determine if correction or optimization of these risk factors can prevent MU after RYGB.
Citation: Rodrigo Duarte-Chavez, MD; Noel B. Martins, MD; Kimberly J. Chaput, DO; Sagar V. Mehta, MD; Maher El Chaar, MD. P2588 - WHAT CAUSES MARGINAL ULCERATION FOLLOWING GASTRIC BYPASS?. Program No. P2588. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.