Marginal ulceration is one of the most common adverse events after Roux-en-Y gastric bypass (RYGB). The inci- dence rate of marginal ulcer may be as high as 7%. 1-3 Anti- secretory therapy is the first-line treatment. However, more than one-third of patients undergo surgical revision for intractable ulcers. 4,5 The surgical outcome is excellent overall, except for smokers. 5,6 Smokers with intractable marginal ulcer pose an extreme management challenge to clinicians. In this video (Video 1, available online at www.VideoGIE.org), we describe an active-smoker patient with recurrent and intractable marginal ulcer despite mul- tiple surgical revisions and use of maximal medical therapy who was successfully treated with endoscopic reversal of RYGB.
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