Background

Marginal ulceration after gastric bypass is a relatively common complication, and in most cases can be managed conservatively with medications. Ulcers that are refractory to medication therapy can worsen, leading to hemorrhage or perforation. In these cases operative intervention is often necessary. This series of five cases highlights patients who had marginal ulcerations that were refractory to maximal medical therapy, however none were candidates for operative intervention. As such, each patient underwent endoscopic suturing of mucosal flaps to cover the ulcerations using the Overstitch device. In each case, the patients had resolution of their symptoms, and upon reevaluation via endoscopy, the area of ulceration covered by the flaps healed completely. However, if the ulcer was not covered completely by the flaps, the exposed areas did not completely heal if the reason for ulceration was not stopped (ie. smoking). In patients who are unable to undergo revision for their refractory marginal ulcers, this provides an option for treatment with excellent short term results. Further study with long term follow up for these patients is needed to assess the viability of the treatment as a permanent solution to this vexing problem.