{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:50:12Z","timestamp":1792270212727,"version":"4.4.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004375","name":"Tel Aviv University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Gastro-Jejunal anastomotic ulcer is a late complication of bariatric surgery, typically responsive to high-dose proton pump inhibitors (PPI). However, persistent ulcers may require surgery. Endoscopic suturing of a jejunal flap has recently shown promise. This study evaluates its implementation in our practice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We retrospectively analyzed 11 patients with refractory marginal ulcers (\u2265\u200910mm) unresponsive to at least two months of high-dose PPI. In cases with a narrow anastomosis, a self-expandable metallic stent was added. Clinical success was defined as ulcer healing on endoscopy at 8 weeks, while failure included persistent ulcer, perforation, or need for surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Seven patients had undergone Roux-en-Y gastric bypass (RYGB) and four had one-anastomosis gastric bypass (OAGB). Ulcers were diagnosed on average 33 months post surgery. All patients were H. pylori-negative and denied alcohol\/NSAID use; four were active smokers. Patients had been on chronic PPI therapy for an average of 25 months. Jejunal flap suturing was performed in 10 patients, with three also receiving a stent. One patient underwent stent placement alone due to stricture to relief obstructive symptoms. The technical success rate was 90.9%, but clinical success was 45%, with four patients requiring surgery. Notably, all OAGB patients had endoscopic failure, while 5 of 7 RYGB patients had ulcer healing.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Jejunal flap suturing showed moderate success in treating marginal ulcers, with a good safety profile. Larger studies are needed to corroborate these findings, especially in OAGB patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-11831-0","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T12:41:39Z","timestamp":1751892099000},"page":"5078-5084","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic jejunal flap suturing for the treatment of refractory marginal ulcers\u2014a case series"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2080-0096","authenticated-orcid":false,"given":"Tali","family":"Bar-On","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Relly","family":"Reicher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan Aviv","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shai","family":"Eldar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danit","family":"Dayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Abu-Abeid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigal","family":"Fishman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mati","family":"Shnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"issue":"2","key":"11831_CR1","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1590\/S0004-28032010000200003","volume":"47","author":"AB Garrido Jr","year":"2010","unstructured":"Garrido AB Jr, Rossi M, Lima SE Jr, Brenner AS, Gomes CA Jr (2010) Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study. Arq Gastroenterol 47(2):130\u2013134","journal-title":"Arq Gastroenterol"},{"issue":"5","key":"11831_CR2","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1381\/096089298765554061","volume":"8","author":"JA Sapala","year":"1998","unstructured":"Sapala JA, Wood MH, Sapala MA, Flake TM Jr (1998) Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 8(5):505\u2013516","journal-title":"Obes Surg"},{"issue":"12","key":"11831_CR3","doi-asserted-by":"publisher","first-page":"4974","DOI":"10.1007\/s11695-020-04864-y","volume":"30","author":"A Baksi","year":"2020","unstructured":"Baksi A, Kamtam DNH, Aggarwal S, Ahuja V, Kashyap L, Shende DR (2020) Should surveillance endoscopy be routine after one anastomosis gastric bypass to detect marginal ulcers: initial outcomes in a tertiary referral centre. Obes Surg 30(12):4974\u20134980","journal-title":"Obes Surg"},{"issue":"9","key":"11831_CR4","doi-asserted-by":"publisher","first-page":"2721","DOI":"10.1007\/s11695-019-04005-0","volume":"29","author":"DE Magouliotis","year":"2019","unstructured":"Magouliotis DE, Tasiopoulou VS, Tzovaras G (2019) One anastomosis gastric bypass versus Roux-en-Y Gastric Bypass for morbid obesity: an updated meta-analysis. Obes Surg 29(9):2721\u20132730","journal-title":"Obes Surg"},{"issue":"5","key":"11831_CR5","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1007\/s11695-014-1482-9","volume":"25","author":"UK Coblijn","year":"2015","unstructured":"Coblijn UK, Lagarde SM, de Castro SM, Kuiken SD, van Wagensveld BA (2015) Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg 25(5):805\u2013811","journal-title":"Obes Surg"},{"issue":"5","key":"11831_CR6","doi-asserted-by":"publisher","first-page":"2347","DOI":"10.1007\/s00464-020-07650-0","volume":"35","author":"A Di Palma","year":"2021","unstructured":"Di Palma A, Liu B, Maeda A, Anvari M, Jackson T, Okrainec A (2021) Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surg Endosc 35(5):2347\u20132353","journal-title":"Surg Endosc"},{"issue":"7","key":"11831_CR7","doi-asserted-by":"publisher","first-page":"2331","DOI":"10.1007\/s11695-024-07298-y","volume":"34","author":"A Kupietzky","year":"2024","unstructured":"Kupietzky A, Dodi O, Cohen N, Dover R, Maden A, Mazeh H, Grinbaum R, Mizrahi I (2024) Similar rates of symptomatic marginal ulcers after one-anastomosis-gastric bypass compared to Roux-en-Y Gastric Bypass. 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Obes Surg 28(8):2252\u20132260","journal-title":"Obes Surg"},{"issue":"6","key":"11831_CR14","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1177\/15533506241290071","volume":"31","author":"M Alomari","year":"2024","unstructured":"Alomari M, Wadiwala I, Bowers S, Elli EF, Thomas M (2024) Oxygen saturation endoscopic imaging as a novel alternative to assess tissue perfusion during esophagectomy. 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Patients were prospectively followed as part of a cohort study authorized by the institutional ethics committee. Informed consent was obtained prior to the procedure from all individual participants included in this study. Demographics, clinical and procedural details, and outcomes were gathered and assessed by a physician of the bariatric service, either in person during follow-up visits or by phone interview.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}