9th Annual Association for Bariatric Endoscopy (ABE) Meeting | May 2024 ABEAM2024-Marginal Ulcers: Medical, Endoscopic, & Surgical Management + Panel Discussion

Pdf Summary

Marginal ulcers are a relatively common complication post-bariatric surgery, with an incidence ranging from 1-25%. Patients typically present with symptoms such as epigastric pain, nausea, vomiting, hematemesis, or melena. Diagnosis is typically made through upper endoscopy, upper GI series, or CT scan if perforation is suspected. Risk factors for marginal ulcers include factors related to surgery, such as the size of the pouch, type of anastomosis, and patient-related factors like smoking, NSAID use, and H. pylori infection.<br /><br />Treatment involves a combination of proton pump inhibitors (PPIs) and Carafate for 8-12 weeks, with surveillance endoscopies to monitor healing progress. If healing is not achieved, additional interventions like oversewing, stent placement, or surgical intervention may be required. A case presentation highlighted a 45-year-old female with a contained perforation two months post-Roux-en-Y surgery presenting with upper gastrointestinal bleeding, managed with PPIs.<br /><br />A panel discussion suggested options like surgery, oversewing the ulcer, or continuing medical management. In the case, the ulcer was oversewn, and a lumen-apposing metal stent (LAMS) was placed. Follow-up at 3 months and 1 year was mentioned, but further details were not provided. The document provides a concise overview of the diagnosis, risk factors, and management strategies for marginal ulcers post-bariatric surgery, highlighting the importance of close monitoring and appropriate interventions based on individual patient needs.

Asset Subtitle

Eric J. Vargas, MD, MS, ABOM

Keywords

marginal ulcers

bariatric surgery

complications

epigastric pain

diagnosis

risk factors

proton pump inhibitors

Carafate

surveillance endoscopies

lumen-apposing metal stent