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Upper gastrointestinal haemorrhage following coronary artery bypass grafting
I D Norton1, C S Pokorny, D K Baird
1Department of Gastroenterology, Prince of Wales Hospital, Sydney, NSW.
Insights
Upper gastrointestinal (GI) bleeding after coronary artery bypass graft (CABG) surgery is common, often caused by duodenal ulcers. Endoscopy is a safe diagnostic tool for these patients, with outcomes similar to those not experiencing bleeding.
Area of Science:
- Gastroenterology
- Cardiology
- Surgical Complications
Background:
- Upper gastrointestinal (UGI) bleeding is a significant, potentially fatal complication following coronary artery bypass graft (CABG) surgery.
- The incidence, predisposing factors, and safety of endoscopic interventions for UGI bleeding post-CABG remain incompletely understood.
Purpose of the Study:
- To determine the incidence, common sites, contributing factors, and outcomes of UGI bleeding after CABG.
- To evaluate the safety and efficacy of UGI endoscopy in managing post-CABG bleeding.
Main Methods:
- A retrospective analysis of UGI hemorrhage cases in patients who underwent CABG between 1976 and 1991.
- Data collected included bleeding incidence, endoscopic findings, therapeutic interventions, and patient demographics.
Main Results:
- A 0.5% incidence of major UGI hemorrhage was observed post-CABG, with duodenal ulceration being the most frequent cause (82%).
- Endoscopic therapy was initially successful in 87.5% of cases, though 37.5% of these required subsequent surgery due to rebleeding. No endoscopic complications occurred.
- Factors associated with increased bleeding risk included older age, history of peptic ulcer disease, and lower perioperative use of H2-receptor antagonists.
Conclusions:
- Upper GI hemorrhage is a notable complication after CABG, predominantly stemming from duodenal ulcers.
- Upper GI endoscopy is a safe and valuable diagnostic procedure for patients experiencing bleeding post-CABG.
- Mortality rates for CABG patients with and without UGI hemorrhage were comparable.
Background:
Upper gastrointestinal (UGI) bleeding is a relatively common and potentially fatal complication of coronary artery bypass graft (CABG) surgery. However, little is known of this problem, including its incidence, predisposing factors and safety of endoscopy in these patients.
Aim:
To document the incidence, site, predisposing factors and outcome of UGI bleeding following CABG surgery. Also, to assess the safety of UGI endoscopy in these patients.
Method:
Retrospective study of UGI haemorrhage following CABG at one institution between 1976 and 1991.
Results:
Fifty-five of 10,573 patients (0.5%) suffered a major UGI haemorrhage (as defined by need for transfusion or presence of melaena or haematemesis associated with hypotension). Of 51 patients undergoing endoscopy or laparotomy, 42 (82%) bled from duodenal ulceration. Five patients bled from gastric ulcers and one each from oesophagitis and Mallory Weiss tear. Nine patients underwent endoscopic therapy, which initially arrested haemorrhage in eight patients. However, three patients rebled and required surgery. Eight patients underwent surgery as initial therapy, resulting in an overall surgical rate of 20%. One patient died due to multi system failure following surgery. There were no complications from endoscopy. Patients who bled were more likely to have received inotropic support post-operatively prior to the haemorrhage (p < 0.05) and tended to be older than controls (mean age 65.6 years vs 58.7 years, p < 0.01). Twenty-one of the patients (38%) who bled had a past history of peptic ulceration or dyspepsia compared with 9% of controls (p < 0.001). Seven (12.5%) had previously bled from peptic ulceration. Patients who bled were less likely to have received H2-receptor antagonists in the perioperative period than controls (4% vs 20%, p < 0.05).
Conclusion:
Upper GI haemorrhage following CABG is relatively frequent. It is usually secondary to duodenal ulceration. Endoscopy is a safe procedure in this patient group. Mortality did not differ between index patients who suffered a UGI haemorrhage and controls undergoing CABG who did not bleed.