Sindhu Barola1, Lea Fayad1, Christine Hill2, Thomas Magnuson3, Michael Schweitzer3, Vikesh Singh1, Yen-I Chen1, Saowanee Ngamruengphong1, Mouen A Khashab1, Anthony N Kalloo1, Vivek Kumbhari4. 1. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA. 2. Diversity Summer Internship Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. 4. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA. vkumbhari@gmail.com.
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.
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.
Authors: Peter B Cotton; Glenn M Eisen; Lars Aabakken; Todd H Baron; Matt M Hutter; Brian C Jacobson; Klaus Mergener; Albert Nemcek; Bret T Petersen; John L Petrini; Irving M Pike; Linda Rabeneck; Joseph Romagnuolo; John J Vargo Journal: Gastrointest Endosc Date: 2010-03 Impact factor: 9.427
Authors: Allison R Schulman; Walter W Chan; Aiofe Devery; Michele B Ryan; Christopher C Thompson Journal: Clin Gastroenterol Hepatol Date: 2016-10-20 Impact factor: 11.382
Authors: Mouen A Khashab; Sepideh Besharati; Saowanee Ngamruengphong; Vivek Kumbhari; Mohamad El Zein; Ellen M Stein; Alan Tieu; Gerard E Mullin; Sameer Dhalla; Monica C Nandwani; Vikesh Singh; Marcia I Canto; Anthony N Kalloo; John O Clarke Journal: Gastrointest Endosc Date: 2015-08-05 Impact factor: 9.427
Authors: Barham K Abu Dayyeh; Andres Acosta; Michael Camilleri; Manpreet S Mundi; Elizabeth Rajan; Mark D Topazian; Christopher J Gostout Journal: Clin Gastroenterol Hepatol Date: 2015-12-31 Impact factor: 11.382
Authors: Christopher C Thompson; Bipan Chand; Yang K Chen; Daniel C DeMarco; Larry Miller; Michael Schweitzer; Richard I Rothstein; David B Lautz; James Slattery; Michele B Ryan; Stacy Brethauer; Phillip Schauer; Mack C Mitchell; Anthony Starpoli; Gregory B Haber; Marc F Catalano; Steven Edmundowicz; Annette M Fagnant; Lee M Kaplan; Mitchell S Roslin Journal: Gastroenterology Date: 2013-04-05 Impact factor: 22.682