Anastomotic marginal ulceration after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass
In brief
Marginal ulcers affected 35% of sleeve-to-bypass patients by 8 years
In this retrospective study, marginal ulcers developed within 8 years in 35% of patients converted from sleeve gastrectomy to gastric bypass, compared with 20% after primary bypass. The findings suggest higher long-term ulcer incidence after conversion, but the study cannot establish why; whether removing the antrum during conversion lowers risk remains an open question.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 8 August 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Fadlullah Ba'th, Xiaoxi Feng, Jesse Gutnick, Toms Augustin, Rickesha Wilson, Jerry T Dang, et al.
- PMID
- 42823264
- DOI
- 10.1016/j.soard.2026.08.007
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 3 October 2026): Anastomotic marginal ulceration after conversion of sleeve gastrectomy to RYGB
Abstract
BACKGROUND: Patients who undergo Roux-en-Y gastric bypass (RYGB) can develop anastomotic marginal ulcers, which can lead to other complications such as stricture, bleeding, or perforation. OBJECTIVES: The study aimed to examine if patients undergoing conversion of sleeve gastrectomy to RYGB (SG-to-RYGB) were at a higher risk of marginal ulceration than a cohort of patients with primary RYGB. SETTING: Cleveland Clinic Health System in the United States. METHODS: This retrospective study included patients who underwent primary RYGB or SG-to-RYGB conversion at an academic health system between 2015 and 2023. Follow-up ended in March 2025. The Kaplan-Meier method was used to estimate the time to incident marginal ulcer. RESULTS: The study included 1910 patients who underwent primary RYGB and 202 patients who underwent SG-to-RYGB conversion. During the follow-up time of 3.8 ± 2.9 years, 275 patients with primary RYGB and 40 patients who had SG-to-RYGB conversion developed a marginal ulcer. The cumulative incidence of marginal ulcer at 5 years was 16% (95% confidence interval [CI], 14%-18%) in the primary RYGB group and 27% (95% CI, 18%-35%) in the SG-to-RYGB group. The cumulative incidence of marginal ulcer at 8 years was 20% (95% CI, 17%-22%) in the primary RYGB group and 35% (95% CI, 20%-47%) in the SG-to-RYGB group (P = .01). In the SG-to-RYGB group, the cumulative incidence of marginal ulcer between patients who underwent RYGB primarily for gastroesophageal reflux disease and those who underwent RYGB for inadequate weight loss following SG was not statistically significant. CONCLUSIONS: The follow-up data up to 8 years indicate that approximately 20% of patients who undergo primary RYGB and 35% of those who undergo SG-to-RYGB conversion may develop marginal ulceration. Given the role of the antrum in acid secretion, future clinical trials could potentially test if antrectomy at the time of conversion of SG-to-RYGB has the potential to decrease the rate of marginal ulceration.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.