American Society for Metabolic and Bariatric Surgery literature review on risk factors, screening recommendations, and prophylaxis for marginal ulcers after metabolic and bariatric surgery.

Abstract

Background: Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.

Objectives: The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).

Setting: A comprehensive review was conducted by members of the American Society for Metabolic and Bariatric Surgery (ASMBS) Clinical Issues Committee, based on available literature from 2000 to the present.

Methods: A systematic search was performed using Ovid MEDLINE and PubMed databases. Relevant studies were screened for inclusion. Technical and patient-related factors were evaluated, and recommendations for MU prevention were formulated.

Results: Several risk factors for MU were identified, including large gastric pouch size, circular stapled anastomoses, use of nonabsorbable sutures, smoking, nonsteroidal anti-inflammatory drugs use, and immunosuppression. While prophylactic proton pump inhibitor (PPI) therapy is widely recommended, its optimal duration remains debated. The role of Helicobacter pylori in MU development is not clearly defined.

Conclusions: Prophylactic PPI therapy for at least 3 months postsurgery significantly reduces the risk of MU. Risk stratification and individualized treatment plans are essential to minimize postoperative complications. Further research is needed to clarify the role of H. pylori and optimize prophylactic strategies.