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Published in: Obesity Surgery 8/2018

01-08-2018 | Original Contributions

Endoscopic Management of Recalcitrant Marginal Ulcers by Covering the Ulcer Bed

Authors: Sindhu Barola, Lea Fayad, Christine Hill, Thomas Magnuson, Michael Schweitzer, Vikesh Singh, Yen-I Chen, Saowanee Ngamruengphong, Mouen A. Khashab, Anthony N. Kalloo, Vivek Kumbhari

Published in: Obesity Surgery | Issue 8/2018

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Abstract

Background

Management options for marginal ulcers (MU) vary from medical therapy to revision surgery. Medical therapy is often ineffective and revision surgery is associated with a high morbidity and possible recurrence.

Aims

To evaluate technical feasibility, efficacy, and safety of endoscopic management of MU by covering the ulcer bed using oversewing and/or deploying a fully covered self-expandable metallic stent (FCSEMS).

Methods

Medical records of consecutive patients who underwent endoscopic suturing and/or FCSEMS deployment for recalcitrant MU between August 2016 and June 2017 at a single academic center were reviewed. Recalcitrant MU was defined as an ulcer that persists after 6 to 8 weeks despite maximal medical therapy (open capsule PPI, 40 mg bid as well as sucralfate qid), cessation of smoking and nonsteroidal anti-inflammatory drugs (NSAIDs), and Helicobacter pylori eradication.

Results

Eleven patients (age range 31–60; all females) with mean BMI of 27.72 ± 5.93 kg/m2 underwent endoscopic suturing and/or stent deployment for recalcitrant MU with abdominal pain at a median of 50 months (range 3–120) post-Roux-en-Y gastric bypass (RYGB). Seven patients were managed by oversewing, two were managed by FCSEMS, and two patients required both. Technical success was 100%. All patients reported resolution of abdominal pain at 1 week. Surveillance endoscopy performed in 10/11 (90.9%) patients at 8 weeks revealed complete ulcer healing in 9/10 (90%). No adverse events were reported.

Conclusion

Endoscopic management is an effective and safe method to treat MU and should be considered an alternative to surgical revision. It appears effective for perforated and recalcitrant MU.
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Metadata
Title
Endoscopic Management of Recalcitrant Marginal Ulcers by Covering the Ulcer Bed
Authors
Sindhu Barola
Lea Fayad
Christine Hill
Thomas Magnuson
Michael Schweitzer
Vikesh Singh
Yen-I Chen
Saowanee Ngamruengphong
Mouen A. Khashab
Anthony N. Kalloo
Vivek Kumbhari
Publication date
01-08-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3162-7

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