Predictors of endoscopic findings after Roux-en-Y gastric bypass.
OBJECTIVE
To evaluate predictors of endoscopic findings in symptomatic patients after Roux-en-Y gastric bypass (RYGBP) for obesity.


METHODS
A retrospective chart review of 1,001 RYGBP procedures was performed. Two hundred twenty-six (23%) patients were identified as having endoscopy to evaluate upper gastrointestinal symptoms following surgery. Polychotomous logistic regression analysis was used to assess predictors of normal endoscopy, marginal ulcers, stomal stenosis, and staple-line dehiscence.


RESULTS
The most common endoscopic findings were 99 (44%) normal postsurgical anatomy, 81 (36%) marginal ulcer, 29 (13%) stomal stenosis, and 8 (4%) staple-line dehiscence. Factors that significantly increase the risk of marginal ulcers following surgery include smoking (AOR = 30.6, 95% CI 6.4-146) and NSAID use (AOR = 11.5, 95% CI 4.8-28). PPI therapy following surgery was protective against marginal ulcers (AOR = 0.33, 95% CI 0.11-0.97). Median time for diagnosis of marginal ulcers following surgery was 2 months, and 77 of 81 (95%) presented within 12 months.


CONCLUSIONS
Following RYGBP surgery for obesity, smoking and NSAID use significantly increase the risk of marginal ulceration, and PPI therapy is protective. Because a significant majority of marginal ulcers present within 12 months of surgery, it may be reasonable to consider prophylactic PPI therapy during this time period, especially for high risk patients.
Wilson
Jason A
JA
Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Romagnuolo
Joseph
J
Byrne
T Karl
TK
Morgan
Katherine
K
Wilson
Frederick A
FA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016145:Endoscopy, Digestive System; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D017506:H(+)-K(+)-Exchanging ATPase / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology* / Q000601:surgery*; D010437:Peptic Ulcer / Q000209:etiology / Q000473:pathology*; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D054047:Surgical Stomas / Q000473:pathology*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000473:pathology*; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D017506:H(+)-K(+)-Exchanging ATPase