Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Total Enrollment
50 participants
Study Classification
OBSERVATIONAL
Study Start Date
2008-12-31
Study Completion Date
2009-12-31
Brief Summary
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The purpose of this study is to determine the feasibility, safety, and efficacy of revision gastroplasty along with other adjunct procedures in the treatment of intractable / chronic marginal ulcers after Roux-en-Y gastric bypass. A secondary aim is the identification of good and poor outcome predictors after revisional strategies for intractable or chronic marginal ulcer.
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Detailed Description
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The epidemic of overweight and obesity in the United States of America along with its comorbidities continues to expand. Bariatric surgery has demonstrated to be the most effective and sustained method to control severe obesity and its comorbidities. For instance, type 2 diabetes mellitus was completely resolved in 76.8%, systemic arterial hypertension was resolved in 61.7%, dyslipidemia improved in 70% and obstructive sleep apnea-hypopnea syndrome was resolved in 85.7%. Furthermore, bariatric surgery significantly increases life expectancy (89%) and decreases overall mortality (30-40%), particularly deaths from diabetes, heart disease, and cancer. Lastly, preliminary evidence about downstream savings associated with bariatric surgery offset the initial costs in 2 to 4 years.
Since 1998, there has been a substantially progressive increase in bariatric surgery. In 2005, the ASMBS reported that 81% of bariatric procedures were approached laparoscopically and in 2007, 205,000 people had bariatric surgery in the United States from which approximately 80% of these were Gastric Bypass. Moreover, there is a mismatch between eligibility and receipt of bariatric surgery with just less than 1% of the eligible population being treated for morbid obesity through bariatric surgery. Along with the increasing number of elective primary weight loss procedures, up to 20% of post RYGB patients cannot sustain their weight loss beyond 2 to 3 years after the primary bariatric procedure. Thus, revisional surgery for poor weight loss and re-operations for technical or mechanical complications will rise in a parallel manner.
A common late complication after gastric bypass surgery is marginal ulceration, an ulcer at the margins of the gastrojejunostomy on the jejunal side. Its incidence after RYGB ranges from as low as 0.6 to as high as 16%. After 1,040 laparoscopic RYGB surgeries, the incidence rate, in our hands, is 1.4% and mainly related to NSAID´s use. In observational cohort studies, the presence of specific technical factors - staple-line dehiscence or gastro-gastric fistula, enlarged pouch, foreign material and local ischemia - and environmental factors - tobacco, NSAID´s, alcohol consumption, and H pylori infection among others - have been associated with marginal ulceration however the exact etiopathogenesis has not been completely elucidated.
Similar to peptic ulcer disease (PUD), most marginal ulcers respond to medical therapy, specifically sucralfate and acid-lowering medication. In contrast, when perforation, obstruction, penetration, bleeding and/or intractability presents, complex or complicated ulcer disease, warrants surgical intervention.
The intestinal mucosa is not typically exposed to gastric acid, which is neutralized by the alkaline biliopancreatic secretions. The jejunal mucosa has no natural barriers; when exposed to gastric acid, it ulcerates easily. Capella \& Capella demonstrated that transecting the gastric segments significantly reduce staple-line dehiscence; this is the so-called divided gastric bypass. In the retrospective analysis of their consecutive series, the incidence for gastro-gastric fistula (GGF) formation after undivided gastric bypass (GBP) was 23%, after a partially divided GBP was 19%, after a completely divided GBP was 2% and after complete transection with interposition of the jejunal limb was 0% (p \<0.001). MacLean et al confirmed that divided primary gastric bypass decreases GGF formation (29% vs. 3%). Also, patients who developed marginal ulcers had a lower pH as well as a greater time with a pH less than 2 correlating 100% with the presence of GGF; closure of the GGF increased the pH in the pouch with subsequent healing of the marginal ulcer.
An unusually large gastric pouch (such as horizontal pouches, retained fundus, long lesser curvature based pouches or enlarged after initially being sized adequately) contain more acid-producing parietal cells. Increased acid production in the pouch carries the risk of developing marginal ulcers. Acid secretion in the small pouch after RYGB is virtually absent. Smith et al measured basal and pentagastrin-stimulated gastric acid secretion from the pouch were significantly lower compared to age and sex-matched controls. Likewise, MacLean et al reported a significantly lower pH \& greater time with pH \<2 in the gastric pouches of marginal ulcers and/or GGF patients after RYGB compared to non-complicated RYGB controls. Thus, creating a esophagojejunostomy would solve the gastric acid factor for developing marginal ulcers however the high incidence of anastomotic failure and unknown weight loss results are prohibitive for this approach. Sapala et al created a micro-pouch or cardiojejunostomy to decrease at maximum the parietal cell mass with a low incidence of marginal ulcers (0.01% at 1 years of follow-up) as well as to limit the pouch dilation. By Histopathology with a semi-quantitative approach, Gustavsson et al reported less acid-producing parietal cells within smaller pouches. With his next study (n=12), Gustavsson et al, demonstrated a significantly higher time exposure to a pH\<4 in patients with marginal ulcer after RYGB (4x3cm pouch) compared to controls (p\< 0.01). Furthermore, after downsizing the pouch, repeated pH-metry showed the % of time with pH \<4 declined from 100% prior to 6% after revisionary surgery.
The anastomotic techniques influence the incidence of marginal ulcers. Capella \& Capella reported a consecutive series with significant decrement from 5.1% to 1.5% (p\< 0.001) after switching from a stapled to a hand-sewn anastomosis. Likewise, after changing from an inner layer of absorbable suture and an outer layer of nonabsorbable material to a double-layer of absorbable suture the incidence rate improved from 1.6% to 0%. Dr Schauer´s group confirmed a significant improvement in the incidence rate of MU from a 2.6% with the use of nonabsorbable suture for the outer layer to 1.3% after the change to absorbable suture for both layers (p \< 0.001).
Local ischemia, in the immediate postoperative period, is probably secondary to technical reasons. Fundamental aspects for decreasing tension and local ischemia at the gastrojejunostomy are dissection of the tissues around the pouch without devascularizing the lesser curvature and complete mobilization of a well-perfused Roux limb.
In epidemiological, clinical and experimental studies, NSAID´s have been identified as one of the three major risk factors for PUD. Wilson et al found NSAID´s consumption to significantly increase the risk for marginal ulcer following RYGB (adjusted OR 11.5, 95%CI 4.8-28).
In epidemiological, clinical and experimental studies, Tobacco is another major risk factor for PUD. Smoking carries an overall relative risk of 2.2 (95%CI, 2.0-2.3).
Helicobacter pylori (H pylori) infection carries an overall relative risk of 3.3 (95%CI, 2.6-4.4) for developing PUD. A synergistic relationship exists between H pylori infection and NSAID´s consumption for developing PUD with an overall risk of 3.5 (95%CI, 1.26-9.96) compared to either H pylori or NSAID´s negative individuals. In Papasavas et al study, preoperative H. pylori testing with prophylactic eradication did not decrease the incidence of MU or erosive pouch gastritis.
The pathophysiological mechanisms of damage to the gastric mucosa of ethanol and alcoholic beverages are poorly understood. There are no studies available about the effect of alcohol on marginal ulcer development after RYGB.
Cocaine use is responsible for approximately 143,000 Emergency Department visits annually; 19% of American, between 18 to 25 years old, have used cocaine: more than 1% of the Americans use cocaine at least once a week; and approximately 50% of all drug-related deaths were secondary to Cocaine. The temporal association between smoking cocaine (crack) and GI tract manifestations include ulceration, perforation, visceral infarction, and retroperitoneal fibrosis.
Re-operative strategies for addressing chronic marginal ulcers after gastric bypass have been scarcely described and mostly are reports of a case or small series of cases. The revisional strategies described are I) ulcer excision with revision of the gastrojejunostomy and gastric transection if needed, II) ulcer excision with pouch downsizing and redo of gastrojejunostomy, III) ulcer excision with resection of the ischemic Roux limb segment, and IV) ulcer excision and reversal. The possible adjuvant procedures includes I) proximal remnant gastrectomy (partial gastrectomy), and II) vagotomy.
In summary, there is scant information about late complications after gastric bypass especially after the widespread adoption of the laparoscopic approach and the modern anatomical construct of Roux-en-Y Gastric Bypass surgery.
Since 1998, there has been a substantially progressive increase in bariatric surgery. In 2005, the ASMBS reported that 81% of bariatric procedures were approached laparoscopically and in 2007, 205,000 people had bariatric surgery in the United States from which approximately 80% of these were Gastric Bypass. Moreover, there is a mismatch between eligibility and receipt of bariatric surgery with just less than 1% of the eligible population being treated for morbid obesity through bariatric surgery. Along with the increasing number of elective primary weight loss procedures, up to 20% of post RYGB patients cannot sustain their weight loss beyond 2 to 3 years after the primary bariatric procedure. Thus, revisional surgery for poor weight loss and re-operations for technical or mechanical complications will rise in a parallel manner.
A common late complication after gastric bypass surgery is marginal ulceration, an ulcer at the margins of the gastrojejunostomy on the jejunal side. Its incidence after RYGB ranges from as low as 0.6 to as high as 16%. After 1,040 laparoscopic RYGB surgeries, the incidence rate, in our hands, is 1.4% and mainly related to NSAID´s use. In observational cohort studies, the presence of specific technical factors - staple-line dehiscence or gastro-gastric fistula, enlarged pouch, foreign material and local ischemia - and environmental factors - tobacco, NSAID´s, alcohol consumption, and H pylori infection among others - have been associated with marginal ulceration however the exact etiopathogenesis has not been completely elucidated.
Similar to peptic ulcer disease (PUD), most marginal ulcers respond to medical therapy, specifically sucralfate and acid-lowering medication. In contrast, when perforation, obstruction, penetration, bleeding and/or intractability presents, complex or complicated ulcer disease, warrants surgical intervention.
The intestinal mucosa is not typically exposed to gastric acid, which is neutralized by the alkaline biliopancreatic secretions. The jejunal mucosa has no natural barriers; when exposed to gastric acid, it ulcerates easily. Capella \& Capella demonstrated that transecting the gastric segments significantly reduce staple-line dehiscence; this is the so-called divided gastric bypass. In the retrospective analysis of their consecutive series, the incidence for gastro-gastric fistula (GGF) formation after undivided gastric bypass (GBP) was 23%, after a partially divided GBP was 19%, after a completely divided GBP was 2% and after complete transection with interposition of the jejunal limb was 0% (p \<0.001). MacLean et al confirmed that divided primary gastric bypass decreases GGF formation (29% vs. 3%). Also, patients who developed marginal ulcers had a lower pH as well as a greater time with a pH less than 2 correlating 100% with the presence of GGF; closure of the GGF increased the pH in the pouch with subsequent healing of the marginal ulcer.
An unusually large gastric pouch (such as horizontal pouches, retained fundus, long lesser curvature based pouches or enlarged after initially being sized adequately) contain more acid-producing parietal cells. Increased acid production in the pouch carries the risk of developing marginal ulcers. Acid secretion in the small pouch after RYGB is virtually absent. Smith et al measured basal and pentagastrin-stimulated gastric acid secretion from the pouch were significantly lower compared to age and sex-matched controls. Likewise, MacLean et al reported a significantly lower pH \& greater time with pH \<2 in the gastric pouches of marginal ulcers and/or GGF patients after RYGB compared to non-complicated RYGB controls. Thus, creating a esophagojejunostomy would solve the gastric acid factor for developing marginal ulcers however the high incidence of anastomotic failure and unknown weight loss results are prohibitive for this approach. Sapala et al created a micro-pouch or cardiojejunostomy to decrease at maximum the parietal cell mass with a low incidence of marginal ulcers (0.01% at 1 years of follow-up) as well as to limit the pouch dilation. By Histopathology with a semi-quantitative approach, Gustavsson et al reported less acid-producing parietal cells within smaller pouches. With his next study (n=12), Gustavsson et al, demonstrated a significantly higher time exposure to a pH\<4 in patients with marginal ulcer after RYGB (4x3cm pouch) compared to controls (p\< 0.01). Furthermore, after downsizing the pouch, repeated pH-metry showed the % of time with pH \<4 declined from 100% prior to 6% after revisionary surgery.
The anastomotic techniques influence the incidence of marginal ulcers. Capella \& Capella reported a consecutive series with significant decrement from 5.1% to 1.5% (p\< 0.001) after switching from a stapled to a hand-sewn anastomosis. Likewise, after changing from an inner layer of absorbable suture and an outer layer of nonabsorbable material to a double-layer of absorbable suture the incidence rate improved from 1.6% to 0%. Dr Schauer´s group confirmed a significant improvement in the incidence rate of MU from a 2.6% with the use of nonabsorbable suture for the outer layer to 1.3% after the change to absorbable suture for both layers (p \< 0.001).
Local ischemia, in the immediate postoperative period, is probably secondary to technical reasons. Fundamental aspects for decreasing tension and local ischemia at the gastrojejunostomy are dissection of the tissues around the pouch without devascularizing the lesser curvature and complete mobilization of a well-perfused Roux limb.
In epidemiological, clinical and experimental studies, NSAID´s have been identified as one of the three major risk factors for PUD. Wilson et al found NSAID´s consumption to significantly increase the risk for marginal ulcer following RYGB (adjusted OR 11.5, 95%CI 4.8-28).
In epidemiological, clinical and experimental studies, Tobacco is another major risk factor for PUD. Smoking carries an overall relative risk of 2.2 (95%CI, 2.0-2.3).
Helicobacter pylori (H pylori) infection carries an overall relative risk of 3.3 (95%CI, 2.6-4.4) for developing PUD. A synergistic relationship exists between H pylori infection and NSAID´s consumption for developing PUD with an overall risk of 3.5 (95%CI, 1.26-9.96) compared to either H pylori or NSAID´s negative individuals. In Papasavas et al study, preoperative H. pylori testing with prophylactic eradication did not decrease the incidence of MU or erosive pouch gastritis.
The pathophysiological mechanisms of damage to the gastric mucosa of ethanol and alcoholic beverages are poorly understood. There are no studies available about the effect of alcohol on marginal ulcer development after RYGB.
Cocaine use is responsible for approximately 143,000 Emergency Department visits annually; 19% of American, between 18 to 25 years old, have used cocaine: more than 1% of the Americans use cocaine at least once a week; and approximately 50% of all drug-related deaths were secondary to Cocaine. The temporal association between smoking cocaine (crack) and GI tract manifestations include ulceration, perforation, visceral infarction, and retroperitoneal fibrosis.
Re-operative strategies for addressing chronic marginal ulcers after gastric bypass have been scarcely described and mostly are reports of a case or small series of cases. The revisional strategies described are I) ulcer excision with revision of the gastrojejunostomy and gastric transection if needed, II) ulcer excision with pouch downsizing and redo of gastrojejunostomy, III) ulcer excision with resection of the ischemic Roux limb segment, and IV) ulcer excision and reversal. The possible adjuvant procedures includes I) proximal remnant gastrectomy (partial gastrectomy), and II) vagotomy.
In summary, there is scant information about late complications after gastric bypass especially after the widespread adoption of the laparoscopic approach and the modern anatomical construct of Roux-en-Y Gastric Bypass surgery.
Conditions
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Marginal Ulcer
Chronic Ulcer Disease
Persistent Ulcer Disease
Recurrent Ulcer Disease
Late Morbidity After Gastric Bypass
Study Design
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Observational Model Type
COHORT
Study Time Perspective
RETROSPECTIVE
Study Groups
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Chronic marginal ulcer after RYGB
Patients with intractable or chronic marginal ulcer disease after gastric bypass complaining of abdominal pain, GI bleeding, obstruction, perforation and penetration. Sometimes with other associated diagnosis such as narcotic and tobacco dependence, protein-calorie malnutrition, excessive weight loss, poor pouch emptying syndrome, weight regain, inadequate initial weight loss, severe dumping syndrome among others.
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
* Chronic/Intractable, either recurrent or persistent, marginal ulcers after Roux-en-Y gastric bypass surgery for clinically severe obesity
Exclusion Criteria
* Chronic or Intractable marginal ulcer after other bariatric procedures
* Revision or re-operation by open approach
* missing records and/or unreachable patients with scant information for analysis
* Revision or re-operation by open approach
* missing records and/or unreachable patients with scant information for analysis
Minimum Eligible Age
18 Years
Maximum Eligible Age
65 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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University of California, San Francisco
OTHER
Sponsor Role
lead
Responsible Party
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UCSF Fresno / ALSA Medical Group, Inc. Minimally Invasive Surgery Program
Principal Investigators
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Francisco M Tercero, MD
Role: STUDY_DIRECTOR
Research Associate, University of California San Francisco
Kelvin D Higa, MD
Role: PRINCIPAL_INVESTIGATOR
Professor of Surgery, University of California San Francisco
Locations
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University of California San Francisco, Department of Surgery/Fresno Medical Education Program
Fresno, California, United States
Site Status
Countries
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United States
References
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Higa KD, Boone KB, Ho T, Davies OG. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000 Sep;135(9):1029-33; discussion 1033-4. doi: 10.1001/archsurg.135.9.1029.
Reference Type
BACKGROUND
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004 Jun 16;291(23):2847-50. doi: 10.1001/jama.291.23.2847.
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BACKGROUND
McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, Lohr KN. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003 Dec 2;139(11):933-49. doi: 10.7326/0003-4819-139-11-200312020-00013.
Reference Type
BACKGROUND
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. doi: 10.1001/jama.292.14.1724.
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BACKGROUND
Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4. doi: 10.1097/01.sla.0000137343.63376.19.
Reference Type
BACKGROUND
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007 Aug 23;357(8):753-61. doi: 10.1056/NEJMoa066603.
Reference Type
BACKGROUND
Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Agren G, Carlsson LM; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007 Aug 23;357(8):741-52. doi: 10.1056/NEJMoa066254.
Reference Type
BACKGROUND
Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008 Sep;14(9):589-96.
Reference Type
BACKGROUND
Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005 Oct 19;294(15):1909-17. doi: 10.1001/jama.294.15.1909.
Reference Type
BACKGROUND
Flum DR, Khan TV, Dellinger EP. Toward the rational and equitable use of bariatric surgery. JAMA. 2007 Sep 26;298(12):1442-4. doi: 10.1001/jama.298.12.1442. No abstract available.
Reference Type
BACKGROUND
Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition. 2008 Sep;24(9):832-42. doi: 10.1016/j.nut.2008.06.027.
Reference Type
BACKGROUND
Nguyen NT. Reoperations and revisions in bariatric surgery. Surg Endosc. 2007 Nov;21(11):1907-8. doi: 10.1007/s00464-007-9572-6. Epub 2007 Sep 8. No abstract available.
Reference Type
BACKGROUND
Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998 Oct;8(5):505-16. doi: 10.1381/096089298765554061.
Reference Type
BACKGROUND
Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients--what have we learned? Obes Surg. 2000 Dec;10(6):509-13. doi: 10.1381/096089200321593706.
Reference Type
BACKGROUND
Sanyal AJ, Sugerman HJ, Kellum JM, Engle KM, Wolfe L. Stomal complications of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol. 1992 Sep;87(9):1165-9.
Reference Type
BACKGROUND
Capella JF, Capella RF. Staple Disruption and Marginal Ulceration in Gastric Bypass Procedures for Weight Reduction. Obes Surg. 1996 Feb;6(1):44-49. doi: 10.1381/096089296765557259.
Reference Type
BACKGROUND
Capella JF, Capella RF. Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg. 1999 Feb;9(1):22-7; discussion 28. doi: 10.1381/096089299765553674.
Reference Type
BACKGROUND
Jordan JH, Hocking MP, Rout WR, Woodward ER. Marginal ulcer following gastric bypass for morbid obesity. Am Surg. 1991 May;57(5):286-8.
Reference Type
BACKGROUND
Sacks BC, Mattar SG, Qureshi FG, Eid GM, Collins JL, Barinas-Mitchell EJ, Schauer PR, Ramanathan RC. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006 Jan-Feb;2(1):11-6. doi: 10.1016/j.soard.2005.10.013.
Reference Type
BACKGROUND
Lublin M, McCoy M, Waldrep DJ. Perforating marginal ulcers after laparoscopic gastric bypass. Surg Endosc. 2006 Jan;20(1):51-4. doi: 10.1007/s00464-005-0325-0. Epub 2005 Dec 7.
Reference Type
BACKGROUND
St Jean MR, Dunkle-Blatter SE, Petrick AT. Laparoscopic management of perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006 Nov-Dec;2(6):668. doi: 10.1016/j.soard.2006.09.011. No abstract available.
Reference Type
BACKGROUND
Chin EH, Hazzan D, Sarpel U, Herron DM. Multimedia article. Laparoscopic repair of a perforated marginal ulcer 2 years after gastric bypass. Surg Endosc. 2007 Nov;21(11):2110. doi: 10.1007/s00464-007-9486-3. Epub 2007 Aug 18.
Reference Type
BACKGROUND
Abstracts of the 2008 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Philadelphia, Pennsylvania, USA, 9-12 April 2008. Surg Endosc. 2008 Apr;22 Suppl 1:144-301. doi: 10.1007/s00464-008-9821-3. No abstract available.
Reference Type
BACKGROUND
Nguyen NT, Hinojosa MW, Gray J, Fayad C. Reoperation for marginal ulceration. Surg Endosc. 2007 Nov;21(11):1919-21. doi: 10.1007/s00464-007-9538-8. Epub 2007 Aug 19. No abstract available.
Reference Type
BACKGROUND
Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009 May-Jun;5(3):317-22. doi: 10.1016/j.soard.2008.10.011. Epub 2008 Nov 6.
Reference Type
BACKGROUND
Madan AK, DeArmond G, Ternovits CA, Beech DJ, Tichansky DS. Laparoscopic revision of the gastrojejunostomy for recurrent bleeding ulcers after past open revision gastric bypass. Obes Surg. 2006 Dec;16(12):1662-8. doi: 10.1381/096089206779319400.
Reference Type
BACKGROUND
Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002 Jan 5;359(9300):14-22. doi: 10.1016/S0140-6736(02)07273-2.
Reference Type
BACKGROUND
Ramaswamy A, Lin E, Ramshaw BJ, Smith CD. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery. Arch Surg. 2004 Oct;139(10):1094-6. doi: 10.1001/archsurg.139.10.1094.
Reference Type
BACKGROUND
Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007 Jul;21(7):1090-4. doi: 10.1007/s00464-007-9285-x. Epub 2007 May 19.
Reference Type
BACKGROUND
Stenstrom B, Loseth K, Bevanger L, Sturegard E, Wadstrom T, Chen D. Gastric bypass surgery does not increase susceptibility to Helicobacter pylori infection in the stomach of rat or mouse. Inflammopharmacology. 2005;13(1-3):229-34. doi: 10.1163/156856005774423791.
Reference Type
BACKGROUND
Yang CS, Lee WJ, Wang HH, Huang SP, Lin JT, Wu MS. The influence of Helicobacter pylori infection on the development of gastric ulcer in symptomatic patients after bariatric surgery. Obes Surg. 2006 Jun;16(6):735-9. doi: 10.1381/096089206777346754.
Reference Type
BACKGROUND
Papasavas PK, Gagne DJ, Donnelly PE, Salgado J, Urbandt JE, Burton KK, Caushaj PF. Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008 May-Jun;4(3):383-8. doi: 10.1016/j.soard.2007.08.014. Epub 2007 Nov 5.
Reference Type
BACKGROUND
Teyssen S, Singer MV. Alcohol-related diseases of the oesophagus and stomach. Best Pract Res Clin Gastroenterol. 2003 Aug;17(4):557-73. doi: 10.1016/s1521-6918(03)00049-0.
Reference Type
BACKGROUND
Bode C, Bode JC. Effect of alcohol consumption on the gut. Best Pract Res Clin Gastroenterol. 2003 Aug;17(4):575-92. doi: 10.1016/s1521-6918(03)00034-9.
Reference Type
BACKGROUND
Glauser J, Queen JR. An overview of non-cardiac cocaine toxicity. J Emerg Med. 2007 Feb;32(2):181-6. doi: 10.1016/j.jemermed.2006.05.044. Epub 2007 Jan 22.
Reference Type
BACKGROUND
Lee HS, LaMaute HR, Pizzi WF, Picard DL, Luks FI. Acute gastroduodenal perforations associated with use of crack. Ann Surg. 1990 Jan;211(1):15-7. doi: 10.1097/00000658-199001000-00003.
Reference Type
BACKGROUND
Arrillaga A, Sosa JL, Najjar R. Laparoscopic patching of crack cocaine-induced perforated ulcers. Am Surg. 1996 Dec;62(12):1007-9.
Reference Type
BACKGROUND
Sharma R, Organ CH Jr, Hirvela ER, Henderson VJ. Clinical observation of the temporal association between crack cocaine and duodenal ulcer perforation. Am J Surg. 1997 Dec;174(6):629-32; discussion 632-3. doi: 10.1016/s0002-9610(97)00215-8.
Reference Type
BACKGROUND
Schuster KM, Feuer WJ, Barquist ES. Outcomes of cocaine-induced gastric perforations repaired with an omental patch. J Gastrointest Surg. 2007 Nov;11(11):1560-3. doi: 10.1007/s11605-007-0257-1. Epub 2007 Aug 15.
Reference Type
BACKGROUND
Mason EE. Warning patients about cocaine and aspirin. Obes Surg. 1998 Jun;8(3):312-3. doi: 10.1381/096089298765554539. No abstract available.
Reference Type
BACKGROUND
Related Links
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http://www.fresno.ucsf.edu/surgery/
"Click here for more information about the department sponsor´s web site"
Other Identifiers
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U1111-1112-9755
Identifier Type: OTHER
Identifier Source: secondary_id
CMC IRB No. 2008078
Identifier Type: -
Identifier Source: org_study_id
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