Incidence rates, risk factors, and treatment of marginal ulcers after OAGB

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Created On: 16/11/2023

A systematic review and meta-analysis was conducted to comprehend the occurrence rates, factors contributing to risk, and approaches to addressing marginal ulcers after one-anastomosis gastric bypass (OAGB).

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Key take away

After one-anastomosis gastric bypass, marginal ulcers occur in approximately 2.59% of cases, with most patients treated conservatively using PPIs.

Background

Method

For relevant literature searches pertaining to OAGB in which authors had reported on marginal ulcers, databases such as Cochrane Library, Scopus, and MEDLINE were explored. Information was gathered concerning risk factors, incidence rates, basic demographics, and the treatment of this condition.

Result

Analysis of 32 studies, encompassing a total of 8,868 volunteers revealed that the body mass index and mean age in the studies were 47.6 ± 5.6 kg/m2 and 40.9 ± 4.5 years, respectively. Within the cohort, around 72% were women, and 20.6% reported preoperative gastroesophageal reflux disease (GERD). Notably, proton-pump inhibitors (PPI) prophylaxis was prescribed to 14.1% of patients postoperatively, with 228 subjects being reported to have developed marginal ulcers.

The occurrence of marginal ulcers was 2.59%, with 53 individuals showing symptoms within a year, 24 patients experiencing symptoms following 31 months, and 5 people reporting symptoms after 6 years. However, there was no recorded presentation time for 146 subjects. Among these cases, 65 patients received a diagnosis of marginal ulcers through endoscopy, comprising 11 asymptomatic and 54 symptomatic individuals. For the remaining 163 volunteers, the authors were not specific on the investigation choice. In terms of treatment, 89.7% of patients were managed conservatively with PPIs, while 10.3% opted for surgical intervention to address marginal ulcers.

Conclusion

Marginal ulcers are rare complications after OAGB, with most patients receiving conservative treatment involving PPIs. There is a need for more extensive and well-structured studies that investigate the risk factors, diagnostic methods, and treatment of these ulcers after OAGB.