TY - JOUR
T1 - Proton pump inhibitor prophylaxis after Roux-en-Y gastric bypass
T2 - A national survey of surgeon practices
AU - American Society for Metabolic and Bariatric Surgery Research Committee
AU - Giannopoulos, Spyridon
AU - Athanasiadis, Dimitrios I.
AU - Clapp, Benjamin
AU - Lyo, Victoria
AU - Ghanem, Omar
AU - Puzziferri, Nancy
AU - Stefanidis, Dimitrios
N1 - Publisher Copyright:
© 2023 American Society for Metabolic and Bariatric Surgery
PY - 2023/4
Y1 - 2023/4
N2 - Background: Proton pump inhibitors (PPIs) are frequently used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer development is unclear. Objectives: Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis. Setting: Survey of medical directors of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited centers. Methods: Members of the American Society for Metabolic and Bariatric Surgery research committee developed and administered a web-based anonymous survey in November 2021 to bariatric surgeons of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited programs detailing questions related to surgeons’ use of PPI after RYGB including patient selection, medication, dosage, and treatment duration. Results: The survey was completed by 112 surgeons (response rate: 52.6%). PPIs were prescribed by 85.4% of surgeons for all patients during their hospitalization, 3.9% for selective patients, and 10.7% not at all. After discharge, 90.3% prescribed PPIs. Pantoprazole was most often used during hospitalization (38.5%), while omeprazole was most prescribed (61.7%) after discharge. The duration of postoperative PPI administration varied; it was 3 months in 43.6%, 1 month in 20.2%, and 6 months in 18.6% of patients. Finally, surgeons’ practice setting and case volume were not associated with the duration of prophylactic PPI administration after RYGB. Conclusions: PPI administration practices vary widely among surgeons after RYGB, which may be related to the limited comparative evidence and guidelines on best duration of PPI administration. Large prospective clinical trials with objective outcome measures are needed to define optimal practices for PPI prophylaxis after RYGB to maximize clinical benefit.
AB - Background: Proton pump inhibitors (PPIs) are frequently used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer development is unclear. Objectives: Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis. Setting: Survey of medical directors of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited centers. Methods: Members of the American Society for Metabolic and Bariatric Surgery research committee developed and administered a web-based anonymous survey in November 2021 to bariatric surgeons of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited programs detailing questions related to surgeons’ use of PPI after RYGB including patient selection, medication, dosage, and treatment duration. Results: The survey was completed by 112 surgeons (response rate: 52.6%). PPIs were prescribed by 85.4% of surgeons for all patients during their hospitalization, 3.9% for selective patients, and 10.7% not at all. After discharge, 90.3% prescribed PPIs. Pantoprazole was most often used during hospitalization (38.5%), while omeprazole was most prescribed (61.7%) after discharge. The duration of postoperative PPI administration varied; it was 3 months in 43.6%, 1 month in 20.2%, and 6 months in 18.6% of patients. Finally, surgeons’ practice setting and case volume were not associated with the duration of prophylactic PPI administration after RYGB. Conclusions: PPI administration practices vary widely among surgeons after RYGB, which may be related to the limited comparative evidence and guidelines on best duration of PPI administration. Large prospective clinical trials with objective outcome measures are needed to define optimal practices for PPI prophylaxis after RYGB to maximize clinical benefit.
KW - Gastric bypass
KW - Marginal ulcer
KW - PPI
KW - Proton pump inhibitor prophylaxis
KW - RYGB
KW - Survey
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U2 - 10.1016/j.soard.2022.10.002
DO - 10.1016/j.soard.2022.10.002
M3 - Article
C2 - 36379840
AN - SCOPUS:85141947243
SN - 1550-7289
VL - 19
SP - 303
EP - 308
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 4
ER -