Late marginal ulcers after gastric bypass for morbid obesity. Clinical and endoscopic findings and response to treatment.

Marginal ulcer (MU) is an occasional complication after gastric bypass which can occur early or late after surgery. In this study, we evaluated the incidence, clinical presentation, and endoscopic behavior of patients with late MU. Five hundred fifty morbidly obese patients were evaluated prospectively performing an endoscopic study 1-8 years after surgery. They were submitted either to laparotomic (n = 392) or laparoscopic (n = 158) approach. Six patients (1%) presented late MU 12 to 84 months after surgery. Four patients had single ulcer, while two patients had multiple ulcers. All were treated with proton pump inhibitors (PPIs). Several endoscopic evaluations were performed in each patient showing healing and no recurrence of the ulcer. Late MU occurs in a small proportion (1%) of patients submitted to gastric bypass. It can be single or multiple. Medical treatment with PPIs achieves healing at a mean time of 7 months. Several endoscopic evaluations should be performed in these patients in order to demonstrate healing of the ulcer and no recurrence.