The Relevance of Gastroscopy in the Diagnostic Work-up for Marginal Ulceration in Patients Presenting with Abdominal Pain Following Laparoscopic Roux-en-Y Gastric Bypass.

Abstract

Introduction and purpose: It is unknown what the incidence of gastroscopy-diagnosed marginal ulceration is, while gastroscopy is a frequently chosen diagnostic modality in patients presenting with abdominal pain with a Roux-en-Y gastric bypass (RYGB) in history. The aim of this study was to examine the incidence and treatment of gastroscopy-diagnosed marginal ulceration in patients presenting with the first episode of abdominal pain after RYGB, in which gastroscopy is chosen as the first step in the diagnostic work-up.

Material and methods: A post hoc analysis was performed of a prospective cohort of 2273 patients undergoing RYGB between 2014 and 2019 in a large non-academic hospital with a dedicated bariatric unit. All patients presenting with abdominal pain > 30 days postoperatively were included. Primary outcome was gastroscopy identified marginal ulceration and treatment.

Results: One hundred two out of 498 patients presenting with abdominal pain after RYGB (20%) underwent gastroscopy as the first diagnostic step. In 84% of these patients, no marginal ulcer was found. Marginal ulceration was observed in 16/102 patients (16%). All patients underwent optimization of PPI treatment and lifestyle advises. Seven patients underwent revisional surgery, at a median of 163 days (range 80-1287) after diagnosis.

Conclusion: In a minority of patients undergoing gastroscopy for abdominal pain post-RYGB, a marginal ulceration is identified. Revisional surgery is rarely needed in all patients undergoing gastroscopy and only performed after several months when complaints persist despite PPI optimization. Only performing gastroscopy when symptoms persist safely reduces the number of gastroscopy for abdominal pain after RYGB.