Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis.
Bariatric surgery
Gastric bypass
Marginal ulcer
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
07
11
2022
accepted:
04
02
2023
medline:
16
6
2023
pubmed:
17
2
2023
entrez:
16
2
2023
Statut:
ppublish
Résumé
Marginal ulcer (MU) is a common complication following Roux-en-Y gastric bypass (RYGB) with an incidence rate of up to 25%. Several studies have evaluated different risk factors associated with MU with inconsistent findings. In this meta-analysis, we aimed to identify the predictors of MU after RYGB. A comprehensive literature search of PubMed, Embase, and Web of Science databases was conducted through April 2022. All studies that used a multivariate model to assess risk factors for MU after RYGB were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 3 studies were obtained within a random-effects model. Fourteen studies with 344,829 patients who underwent RYGB were included. Eleven different risk factors were analyzed. Meta-analysis demonstrated that Helicobacter pylori (HP) infection (OR 4.97 [2.24-10.99]), smoking (OR 2.50 [1.76-3.54]), and diabetes mellitus (OR 1.80 [1.15-2.80]), were significant predictors of MU. Increased age, body mass index, female gender, obstructive sleep apnea, hypertension, and alcohol use were not predictors of MU. There was a trend of an increased risk of MU associated with nonsteroidal anti-inflammatory drugs (OR 2.43 [0.72-8.21]) and a lower risk of MU with proton pump inhibitors use (OR 0.44 [0.11-2.11]). Smoking cessation, optimizing glycemic control, and eradication of HP infection reduce the risk of MU following RYGB. Recognition of predictors of MU after RYGB will allow physicians to identify high-risk patients, improve surgical outcomes, and reduce the risk of MU.
Identifiants
pubmed: 36795250
doi: 10.1007/s11605-023-05619-7
pii: 10.1007/s11605-023-05619-7
doi:
Substances chimiques
Proton Pump Inhibitors
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1066-1077Informations de copyright
© 2023. The Society for Surgery of the Alimentary Tract.
Références
Smith KB, Smith MS. Obesity Statistics. Prim Care. 2016;43(1):121–135, ix.
Giampaoli S, Vannucchi S. [Obesity and diabetes, a global problem: what does recent data tell us?]. Ig Sanita Pubbl. 2016;72(6):561-570.
pubmed: 28214909
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964-973.
doi: 10.1016/S0140-6736(15)00075-6
pubmed: 26369473
Alalwan AA, Friedman J, Park H, Segal R, Brumback BA, Hartzema AG. US national trends in bariatric surgery: A decade of study. Surgery. 2021;170(1):13-17.
doi: 10.1016/j.surg.2021.02.002
pubmed: 33714616
Clapp B, Ponce J, DeMaria E, et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States. Surgery for Obesity and Related Diseases. 2022;18(9):1134-1140.
doi: 10.1016/j.soard.2022.06.284
pubmed: 35970741
Maroun J, Li M, Oyefule O, et al. Ten year comparative analysis of sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch in patients with BMI ≥ 50 kg/m(2). Surg Endosc. 2022;36(7):4946-4955.
doi: 10.1007/s00464-021-08850-y
pubmed: 34731300
Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg. 2014;24(2):299-309.
doi: 10.1007/s11695-013-1118-5
pubmed: 24234733
Chung WC, Jeon EJ, Lee K-M, et al. Incidence and clinical features of endoscopic ulcers developing after gastrectomy. World J Gastroenterol. 2012;18(25):3260-3266.
pubmed: 22783050
Pantea M, Negovan A, Banescu C, et al. Factors Associated with Recurrent Ulcers in Patients with Gastric Surgery after More Than 15 Years: A Cross-Sectional Single-Center Study. Gastroenterology Research and Practice. 2018;2018:8319481.
doi: 10.1155/2018/8319481
pubmed: 30524477
Portela RC, Sharma I, Vahibe A, et al. Aspirin Use as a Risk Factor for Marginal Ulceration in Roux-en-Y Gastric Bypass Patients: A Meta-Analysis of 24,770 Patients. The American Surgeon. 2022:00031348221103647.
Wilson JA, Romagnuolo J, Byrne TK, Morgan K, Wilson FA. Predictors of endoscopic findings after Roux-en-Y gastric bypass. Am J Gastroenterol. 2006;101(10):2194-2199.
doi: 10.1111/j.1572-0241.2006.00770.x
pubmed: 17032183
Azagury DE, Abu Dayyeh BK, Greenwalt IT, Thompson CC. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43(11):950-954.
doi: 10.1055/s-0030-1256951
pubmed: 21997722
Bhayani NH, Oyetunji TA, Chang DC, Cornwell EE, 3rd, Ortega G, Fullum TM. Predictors of marginal ulcers after laparoscopic Roux-en-Y gastric bypass. J Surg Res. 2012;177(2):224-227.
doi: 10.1016/j.jss.2012.06.003
pubmed: 22743116
Di Palma A, Liu B, Maeda A, Anvari M, Jackson T, Okrainec A. Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surg Endosc. 2021;35(5):2347-2353.
doi: 10.1007/s00464-020-07650-0
pubmed: 32424625
Bekhali Z, Sundbom M. Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients. Obesity surgery. 2020;30(11):4422-4427.
doi: 10.1007/s11695-020-04822-8
pubmed: 32638248
Dittrich L, Schwenninger MV, Dittrich K, Pratschke J, Aigner F, Raakow J. Marginal ulcers after laparoscopic Roux-en-Y gastric bypass: analysis of the amount of daily and lifetime smoking on postoperative risk. Surg Obes Relat Dis. 2020;16(3):389-396.
doi: 10.1016/j.soard.2019.11.022
pubmed: 31956065
El-Hayek K, Timratana P, Shimizu H, Chand B. Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned? Surg Endosc. 2012;26(10):2789-2796.
doi: 10.1007/s00464-012-2280-x
pubmed: 22543994
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
doi: 10.1136/bmj.n71
pubmed: 33782057
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000;283(15):2008–2012.
Sverdén E, Mattsson F, Sondén A, et al. Risk Factors for Marginal Ulcer After Gastric Bypass Surgery for Obesity: A Population-based Cohort Study. Ann Surg. 2016;263(4):733-737.
doi: 10.1097/SLA.0000000000001300
pubmed: 26106845
Süsstrunk J, Wartmann L, Mattiello D, Köstler T, Zingg U. Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures. Obes Surg. 2021;31(7):3005-3014.
doi: 10.1007/s11695-021-05363-4
pubmed: 33761070
Boerlage TCC, Wolvers PJD, Bruin SC, et al. Upper endoscopy after Roux-en-Y gastric bypass: diagnostic yield and factors associated with relevant findings. Surg Obes Relat Dis. 2020;16(7):868-876.
doi: 10.1016/j.soard.2020.03.001
pubmed: 32299714
Coblijn UK, Lagarde SM, de Castro SM, Kuiken SD, van Tets WF, van Wagensveld BA. The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: a historic cohort study. Surg Obes Relat Dis. 2016;12(2):246-252.
doi: 10.1016/j.soard.2015.04.022
pubmed: 26381875
Edholm D, Ottosson J, Sundbom M. Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc. 2016;30(5):2011-2015.
doi: 10.1007/s00464-015-4432-2
pubmed: 26194258
Schulman AR, Abougergi MS, Thompson CC. H. pylori as a predictor of marginal ulceration: A nationwide analysis. Obesity (Silver Spring). 2017;25(3):522-526.
doi: 10.1002/oby.21759
pubmed: 28229552
Wennerlund J, Gunnarsson U, Strigård K, Sundbom M. Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors. Surg Obes Relat Dis. 2020;16(5):620-625.
doi: 10.1016/j.soard.2020.01.005
pubmed: 32107170
Rodrigo DC, Jill S, Daniel M, Kimberly C, Maher EC. Which Factors Correlate with Marginal Ulcer After Surgery for Obesity? Obes Surg. 2020;30(12):4821-4827.
doi: 10.1007/s11695-020-04960-z
pubmed: 32939660
Coblijn UK, Lagarde SM, de Castro SMM, Kuiken SD, van Wagensveld BA. Symptomatic Marginal Ulcer Disease After Roux-en-Y Gastric Bypass: Incidence, Risk Factors and Management. Obesity Surgery. 2015;25(5):805-811.
doi: 10.1007/s11695-014-1482-9
pubmed: 25381115
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560.
doi: 10.1136/bmj.327.7414.557
pubmed: 12958120
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603-605.
doi: 10.1007/s10654-010-9491-z
pubmed: 20652370
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634.
doi: 10.1136/bmj.315.7109.629
pubmed: 9310563
Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455-463.
doi: 10.1111/j.0006-341X.2000.00455.x
pubmed: 10877304
Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21(7):1090-1094.
doi: 10.1007/s00464-007-9285-x
pubmed: 17514403
Suerbaum S, Michetti P. Helicobacter pylori Infection. New England Journal of Medicine. 2002;347(15):1175-1186.
doi: 10.1056/NEJMra020542
pubmed: 12374879
Eastwood GL. The Role of Smoking in Peptic Ulcer Disease. Journal of Clinical Gastroenterology. 1988;10.
Endoh K, Leung FW. Effects of smoking and nicotine on the gastric mucosa: a review of clinical and experimental evidence. Gastroenterology. 1994;107(3):864-878.
doi: 10.1016/0016-5085(94)90138-4
pubmed: 7915701
Wu WK, Cho CH. The pharmacological actions of nicotine on the gastrointestinal tract. J Pharmacol Sci. 2004;94(4):348-358.
doi: 10.1254/jphs.94.348
pubmed: 15107574
Carter J, Chang J, Birriel TJ, et al. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis. 2021;17(12):1956-1976.
doi: 10.1016/j.soard.2021.08.024
pubmed: 34629296
Chow A, Neville A, Kolozsvari N. Smoking in bariatric surgery: a systematic review. Surg Endosc. 2021;35(6):3047-3066.
doi: 10.1007/s00464-020-07669-3
pubmed: 32524412
Kang X, Zurita-Macias L, Hong D, Cadeddu M, Anvari M, Gmora S. A comparison of 30-day versus 90-day proton pump inhibitor therapy in prevention of marginal ulcers after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(5):1003-1007.
doi: 10.1016/j.soard.2015.11.010
pubmed: 26948448