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Endoscopic Therapy for Anastomotic Bleeding After Lower Gastrointestinal Surgery in Patients With Crohn's Disease
Weiwei Zheng1, Partha Pal2, Yago González-Lama3
1Center for Inflammatory Bowel Disease and the Global Center of Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York.
Insights
Endoscopic treatment effectively manages anastomotic bleeding in Crohn's disease (CD) patients after surgery. However, significant blood transfusion needs indicate a higher risk for rebleeding, requiring careful monitoring.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopic Interventions
Background:
- Anastomotic bleeding is a complication in Crohn's disease (CD) patients post-lower gastrointestinal surgery.
- Endoscopic management strategies for this condition are not well-established.
Purpose of the Study:
- To identify risk factors for anastomotic bleeding in CD patients.
- To evaluate the efficacy of endoscopic treatment for postoperative anastomotic bleeding.
Main Methods:
- Retrospective analysis of 21 CD patients with anastomotic bleeding from January 2021 to May 2025 across multiple centers.
- Definition of anastomotic bleeding included direct bleeding or hemoglobin decrease ≥2 g/dL.
- One-year follow-up for rebleeding and need for endoscopic reintervention.
Main Results:
- Initial endoscopic treatment achieved hemostasis in all patients.
- Rebleeding occurred in 42.9% of patients.
- Higher rates and volumes of blood transfusion were significantly associated with rebleeding (P=.011, P=.013).
- No endoscopy-associated complications were reported.
Conclusions:
- Endoscopic therapy is safe and effective for most CD patients with anastomotic bleeding.
- The need for initial blood transfusion and high transfusion volume are significant risk factors for rebleeding.
Background And Aims:
Crohn's disease (CD) patients may experience anastomotic bleeding after lower gastrointestinal surgery, but its endoscopic management remains underexplored. We aimed to analyze the risk factors for anastomotic bleeding and the efficacy of endoscopic treatment.
Methods:
We retrospectively analyzed clinical characteristics, endoscopic treatments, and outcomes of CD patients with postoperative anastomotic bleeding from January 2021 to May 2025 at multiple centers. Anastomotic bleeding was defined as (i) direct bleeding (melena/hematochezia) or (ii) hemoglobin decrease ≥2 g/dL. Patients were followed up for 1 year, with rebleeding requiring endoscopic reintervention.
Results:
We included a total of 21 patients with 100% of patients having onsite bleeding controlled with initial endoscopic treatment and 9 patients (42.9%) having rebleeding. There was no statistical difference between the rebleeding group and nonrebleeding group in terms of age, gender, comorbidity, anticoagulation or antiplatelet therapy, clotting disorder, hemoglobin before or after procedure, bleeding type, the Rutgeert's score, and endoscopic treatment. However, a greater number of patients in the rebleeding group required blood transfusion (88.9% vs 33.3%, P value = .011), and a greater volume of blood transfusion 2.0 (2.0-3.5 units) vs 0.0 (0.0-1.8 units) than those in nonrebleeding group (P value = .013). None of the 21 patients had no endoscopy-associated complications.
Conclusion:
Endoscopic therapy appears to be safe and effective for the majority of CD patients with anastomotic bleeding following bowel surgery. The requirement for blood transfusion at the inception, in conjunction with a high volume of blood transfusion appear to be high risk factors for rebleeding.
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