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Emergency endoscopy for gastrointestinal bleeding after bariatric surgery. Therapeutic algorithm

María Luisa García-García¹, Juan Gervasio Martín-Lorenzo¹, José Antonio Torralba-Martínez¹

¹Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España.

Cirugia Espanola

|December 3, 2014

Insights

Gastrointestinal bleeding (GB) after bariatric surgery occurs in 9% of patients. Most cases resolve with conservative management, but endoscopy is vital for severe or recurrent bleeding.

Area of Science:

Bariatric Surgery
Gastrointestinal Complications
Surgical Outcomes

Background:

Gastrointestinal bleeding (GB) is a known complication following bariatric surgery.
Literature reports GB frequency between 2-4% postoperatively.
Early detection and management are crucial for patient outcomes.

Purpose of the Study:

To present institutional experience with GB after bariatric surgery.
To detail the presentation and management of GB.
To propose a treatment algorithm for post-bariatric GB.

Main Methods:

Review of 300 consecutive laparoscopic bariatric surgeries (2004-2012).
Analysis of 280 laparoscopic Roux en Y gastric bypass and 20 sleeve gastrectomy procedures.
Evaluation of patient demographics, clinical presentation, diagnostics, and treatment.

Main Results:

Twenty-seven patients (9%) experienced GB.
Bleeding originated from gastrojejunostomy staple lines (10 patients) or anastomotic ulcers (3 patients).
Therapeutic endoscopy was required for 13 patients; others were managed non-operatively.

Conclusions:

Conservative management is effective for most GB cases post-bariatric surgery.
Endoscopic intervention is indicated for severe or recurrent bleeding.
Multidisciplinary follow-up is essential for early detection and treatment.

Read full analysis

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.

Keywords:

Bariatric surgery Bypass gástrico laparoscópico Cirugía bariátrica Complicaciones postoperatorias Complications Gastrointestinal bleeding Hemorragia gastrointestinal Laparoscopic gastric bypass Morbid obesity Obesidad mórbida Tratamiento Treatment

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