Marginal ulcer after gastric bypass surgery in France: a nationwide, population-based study

Marginal ulcers (MUs) are one of the most common late complications after gastric bypass. In France, the absence of reliable epidemiological data has precluded the formulation of recommendations concerning dosage or total duration of treatment and the establishment of an endoscopic monitoring strategy.

The aim of this study was to describe the frequency and time to onset of MUs following gastric bypass surgery in a nationwide database and to assess risk factors for developing this complication.

We conducted a population-based study. Patients were included using the French Hospital Discharge Database.

All patients who underwent gastric bypass between January 2015 and December 2021 were included and followed up for 1 year. Ulcer diagnosis was based on upper gastrointestinal endoscopy (including day care) or revision surgery. Patients with undocumented clinical suspicion of ulcer were excluded.

A total of 83,450 patients were included. The incidence of ulcers in the year following surgery was 2.11%, with 25% occurring in the first month. The significant factors identified in multivariable analysis were history of Helicobacter pylori infection (adjusted hazard ratio [aHR]: 1.25 [1.07-1.45]), men (aHR: 1.46 [1.31-1.63]), history of ulcers (aHR: 1.51 [1.16-1.97]), smoking (aHR: 1.91 [1.57-2.33]), and postoperative complications (aHR = 6.89 [6.22-7.61]). Increased body mass index and previous bariatric surgery appeared to be protective.

Among French adult patients who had gastric bypass surgery, 2.11% developed a MU within the first year postoperatively. History of bariatric surgery seems well accounted for. However, greater emphasis should be placed on smoking cessation and the consideration of postoperative complications that may arise during the follow-up period.