Background

The current design of biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodenal-ileal bypass with sleeve (SADI-S) emphasizes the importance of the pylorus’ preservation to reduce the incidence of marginal ulcer (MU) and dumping. However, no study has yet reported data on their prevalence. We aimed to assess the incidence of MU and dumping in patients who underwent BPD-DS and SADI-S and identify the predisposing risk factors.

Methods

A multicenter review of patients who underwent BPD-DS or SADI-S between 2008 and 2022 was conducted. Patient baseline demographics, symptoms and management of MU and dumping were collected. Fisher’s exact test was used to analyze the categorical variables and independent samples t-test was used to analyze continuous variables. Data are presented as mean± standard deviation.

Results

919 patients were included (74.6% female; age 42.5 years; BMI 54.6 kg/m2) with mean follow-up of 31.5 months. 774 (84.2%) underwent BPD-DS and 145 (15.8%) SADI-S. 8 patients (0.9%) developed MU and 7 (0.8%) had dumping. Only one (12%) patient underwent surgery for MU. Non-steroidal anti-inflammatory drugs (NSAID) use (p=0.006) and longer operation time (p= 0.047) were significantly associated with MU development. Sleep apnea (p=0.005) was significantly associated with dumping. Primary versus revisional surgery, and BDP-DS versus SADI-S had no statistically significant association with MU/dumping.

Conclusions

The incidences of MU and dumping in BPD-DS and SADI-S were low. NSAID use and longer operation time were associated with an increased risk of MU, whereas sleep apnea was associated with a higher risk of dumping.