Emergency endoscopy for gastrointestinal bleeding after bariatric surgery. Therapeutic algorithm.

Abstract

OBJECTIVE:

Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm.

PATIENTS AND METHOD:

From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy.

RESULTS:

Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively.

CONCLUSION:

Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication.

• Authors: María Luisa García-García, Juan Gervasio Martín-Lorenzo, José Antonio Torralba-Martínez, Ramón Lirón-Ruiz, Joana Miguel Perelló, Benito Flores Pastor, Enrique Pérez Cuadrado, José Luis Aguayo Albasini
• Journal: Cirugia espanola (Cir Esp) Vol. 93 Issue 2 Pg. 97-104 (Feb 2015) ISSN: 1578-147X [Electronic] Spain
• PMID: 25438773 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Topics

• Adult
• Algorithms
• Bariatric Surgery (adverse effects)
• Emergency Treatment
• Gastric Bypass (adverse effects)
• Gastrointestinal Hemorrhage (etiology, surgery)
• Gastroscopy
• Humans
• Male
• Middle Aged
• Postoperative Complications (etiology, surgery)
• Prospective Studies