Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Endoscopic management of postoperative bleeding

  • Sung Hyeok Ryou (Department of Internal Medicine, Dankook University College of Medicine) ;
  • Ki Bae Bang (Department of Internal Medicine, H+ Yangji Hospital)
  • Received : 2023.01.10
  • Accepted : 2023.06.12
  • Published : 2023.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.

Keywords

References

  1. Zafar SN, Miller K, Felton J, et al. Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences. Surg Endosc 2019;33:272-280. 
  2. Kim SH, Han K, Kang G, et al. Risk of postoperative gastrointestinal bleeding and its associated factors: a nationwide population-based study in Korea. J Pers Med 2021;11:1222. 
  3. Moghadamyeghaneh Z, Mills SD, Pigazzi A, et al. Risk factors of postoperative upper gastrointestinal bleeding following colorectal resections. J Gastrointest Surg 2014;18:1327-1333. 
  4. Yang J, Zhang XH, Huang YH, et al. Diagnosis and treatment of abdominal arterial bleeding after radical gastrectomy: a retrospective analysis of 1875 consecutive resections for gastric cancer. J Gastrointest Surg 2016;20:510-520. 
  5. Kassahun WT, Babel J, Mehdorn M. Assessing differences in surgical outcomes following emergency abdominal exploration for complications of elective surgery and high-risk primary emergencies. Sci Rep 2022;12:1349. 
  6. Lessing Y, Pencovich N, Nevo N, et al. Early reoperation following pancreaticoduodenectomy: impact on morbidity, mortality, and long-term survival. World J Surg Oncol 2019;17:26. 
  7. Enderes J, Pillny C, Standop J, et al. Operative re-intervention following pancreatoduodenectomy: what has changed over the last decades. J Clin Med 2022;11:7512. 
  8. Kim KH, Kim MC, Jung GJ, et al. Endoscopic treatment and risk factors of postoperative anastomotic bleeding after gastrectomy for gastric cancer. Int J Surg 2012;10:593-597. 
  9. Jamil LH, Krause KR, Chengelis DL, et al. Endoscopic management of early upper gastrointestinal hemorrhage following laparoscopic Roux-en-Y gastric bypass. Am J Gastroenterol 2008;103:86-91. 
  10. Fernandez de Sevilla Gomez E, Vallribera Valls F, Espin Basany E, et al. Postoperative small bowel and colonic anastomotic bleeding: therapeutic management and complications. Cir Esp 2014;92:463-467. 
  11. Feng J, Chen YL, Dong JH, et al. Post-pancreaticoduodenectomy hemorrhage: risk factors, managements and outcomes. Hepatobiliary Pancreat Dis Int 2014;13:513-522. 
  12. Chen JF, Xu SF, Zhao W, et al. Diagnostic and therapeutic strategies to manage post-pancreaticoduodenectomy hemorrhage. World J Surg 2015;39:509-515. 
  13. Jones S, May AK. Postoperative gastrointestinal hemorrhage. Surg Clin North Am 2012;92:235-242. 
  14. Sapala JA, Wood MH, Sapala MA, et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998;8:505-516. 
  15. Riquoir C, Diaz LA, Chiliquinga D, et al. Management of biliopancreatic limb bleeding after Roux-en-Y gastric bypass: a case report. Clin Endosc 2021;54:754-758. 
  16. Rabl C, Peeva S, Prado K, et al. Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg 2011;21:413-420. 
  17. Gao DJ, Wang SP, Fu XH, et al. Urgent endoscopy improves hemostasis in patients with upper gastrointestinal bleeding following biliary-pancreatic surgery: a retrospective analysis. Surg Laparosc Endosc Percutan Tech 2021;32:228-235. 
  18. Fernandez-Esparrach G, Bordas JM, Pellise M, et al. Endoscopic management of early GI hemorrhage after laparoscopic gastric bypass. Gastrointest Endosc 2008;67:552-555. 
  19. Lou Z, Zhang W, Yu E, et al. Colonoscopy is the first choice for early postoperative rectal anastomotic bleeding. World J Surg Oncol 2014;12:376. 
  20. Park JY, Kim YW, Eom BW, et al. Unique patterns and proper management of postgastrectomy bleeding in patients with gastric cancer. Surgery 2014;155:1023-1029. 
  21. Golda T, Zerpa C, Kreisler E, et al. Incidence and management of anastomotic bleeding after ileocolic anastomosis. Colorectal Dis 2013;15:1301-1308. 
  22. Besson R, Christidis C, Denet C, et al. Management of postoperative bleeding after laparoscopic left colectomy. Int J Colorectal Dis 2016;31:1431-1436. 
  23. Lee S, Ahn JY, Na S, et al. Clinical features of postoperative anastomotic bleeding after gastrectomy and efficacy of endoscopic hemostasis: a case-control study. Surg Endosc 2017;31:3210-3218. 
  24. Jeong O, Park YK, Ryu SY, et al. Predisposing factors and management of postoperative bleeding after radical gastrectomy for gastric carcinoma. Surg Today 2011;41:363-368. 
  25. Tanizawa Y, Bando E, Kawamura T, et al. Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer. Gastric Cancer 2010;13:50-57. 
  26. Yekebas EF, Wolfram L, Cataldegirmen G, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007;246:269-280. 
  27. Garcia-Garcia ML, Martin-Lorenzo JG, Torralba-Martinez JA, et al. Emergency endoscopy for gastrointestinal bleeding after bariatric surgery: therapeutic algorithm. Cir Esp 2015;93:97-104. 
  28. Fecso AB, Samuel T, Elnahas A, et al. Clinical indicators of postoperative bleeding in bariatric surgery. Surg Laparosc Endosc Percutan Tech 2018;28:52-55. 
  29. Floortje van Oosten A, Smits FJ, van den Heuvel DA, et al. Diagnosis and management of postpancreatectomy hemorrhage: a systematic review and meta-analysis. HPB (Oxford) 2019;21:953-961. 
  30. Amr MA, Alzghari MJ, Polites SF, et al. Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis. J Gastrointest Surg 2014;18:1911-1916. 
  31. Wang JB, Zheng CH, Li P, et al. Effect of comorbidities on postoperative complications in patients with gastric cancer after laparoscopy-assisted total gastrectomy: results from an 8-year experience at a large-scale single center. Surg Endosc 2017;31:2651-2660. 
  32. Bongiovanni T, Lancaster E, Ledesma Y, et al. Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period. J Am Coll Surg 2021;232:765-790. 
  33. Bakhos C, Alkhoury F, Kyriakides T, et al. Early postoperative hemorrhage after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg 2009;19:153-157. 
  34. Aoyama T, Atsumi Y, Hara K, et al. Postoperative bleeding after esophagectomy for esophageal cancer in patients receiving antiplatelet and anticoagulation treatment. Anticancer Res 2020;40:2359-2364. 
  35. Schorn S, Demir IE, Vogel T, et al. Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy-a systematic review with meta-analysis. Langenbecks Arch Surg 2019;404:141-157. 
  36. Steger J, Jell A, Ficht S, et al. Systematic review and meta-analysis on colorectal anastomotic techniques. Ther Clin Risk Manag 2022;18:523-539. 
  37. Mayer G, Lingenfelser T, Ell C. The role of endoscopy in early postoperative haemorrhage. Best Pract Res Clin Gastroenterol 2004;18:799-807. 
  38. Lim SG, Lee KM, Kim SS, et al. Endoscopic approach for postoperative complications following laparoscopic-assisted gastrectomy in early gastric cancer: literature review. Hepatogastroenterology 2012;59:1308-1312. 
  39. Thompson SK, Chang EY, Jobe BA. Clinical review: healing in gastrointestinal anastomoses, part I. Microsurgery 2006;26:131-136. 
  40. Morgan RB, Shogan BD. The science of anastomotic healing. Semin Colon Rectal Surg 2022;33:100879. 
  41. Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg 2003;13:62-65. 
  42. Martinez-Serrano MA, Pares D, Pera M, et al. Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol 2009;13:49-53. 
  43. Park JH, Jeong SH, Lee YJ, et al. Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer. Surg Endosc 2020;34:5312-5319. 
  44. Sharma G, Ardila-Gatas J, Boules M, et al. Upper gastrointestinal endoscopy is safe and feasible in the early postoperative period after Roux-en-Y gastric bypass. Surgery 2016;160:885-891. 
  45. Dick A, Byrne TK, Baker M, et al. Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe? Surg Obes Relat Dis 2010;6:643-647. 
  46. Malik AH, East JE, Buchanan GN, et al. Endoscopic haemostasis of staple-line haemorrhage following colorectal resection. Colorectal Dis 2008;10:616-618. 
  47. Shi K, Shen Z, Zhu G, et al. Systematic review with network meta-analysis: dual therapy for high-risk bleeding peptic ulcers. BMC Gastroenterol 2017;17:55. 
  48. Mala T, Sovik TT, Schou CF, et al. Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass. Surg Obes Relat Dis 2013;9:234-237. 
  49. Tang SJ, Rivas H, Tang L, et al. Endoscopic hemostasis using endoclip in early gastrointestinal hemorrhage after gastric bypass surgery. Obes Surg 2007;17:1261-1267. 
  50. Kim JS, Kim BW, Kim DH, et al. Guidelines for nonvariceal upper gastrointestinal bleeding. Gut Liver 2020;14:560-570. 
  51. Steffen R. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg 2003;13:466. 
  52. Lee YC, Wang HP, Yang CS, et al. Endoscopic hemostasis of a bleeding marginal ulcer: hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation. J Gastroenterol Hepatol 2002;17:1220-1225. 
  53. Schmidt A, Golder S, Goetz M, et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding of peptic ulcers. Gastroenterology 2018;155:674-686. 
  54. Jensen DM, Kovacs T, Ghassemi KA, et al. Randomized controlled trial of over-the-scope clip as initial treatment of severe nonvariceal upper gastrointestinal bleeding. Clin Gastroenterol Hepatol 2021;19:2315-2323. 
  55. Tontini GE, Naegel A, Albrecht H, et al. Successful over-the-scope clip (OTSC) treatment for severe bleeding due to anastomotic dehiscence. Endoscopy 2013;45 Suppl 2 UCTN:E343-E344. 
  56. Parsi MA, Jang S. Hemospray for diffuse anastomotic bleeding. Gastrointest Endosc 2014;80:1170. 
  57. Baracat FI, de Moura DTH, Brunaldi VO, et al. Randomized controlled trial of hemostatic powder versus endoscopic clipping for non-variceal upper gastrointestinal bleeding. Surg Endosc 2020;34:317-324. 
  58. Ofosu A, Ramai D, John F, et al. The efficacy and safety of hemospray for the management of gastrointestinal bleeding: a systematic review and meta-analysis. J Clin Gastroenterol 2021;55:e37-e45. 
  59. Granata A, Ligresti D, Curcio G, et al. Hemospray rescue treatment of gastroenteric anastomotic bleeding. Endoscopy 2015;47 Suppl 1 UCTN:E327-E328. 
  60. Gubler C, Metzler JM, Turina M. Hemospray treatment for bleeding intestinal anastomoses in the early postoperative period: a novel non-operative approach. Tech Coloproctol 2016;20:495-498. 
  61. Barola S, Magnuson T, Schweitzer M, et al. Endoscopic suturing for massively bleeding marginal ulcer 10 days post Roux-en-Y gastric bypass. Obes Surg 2017;27:1394-1396. 
  62. Laine L, Barkun AN, Saltzman JR, et al. ACG Clinical Guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol 2021;116:899-917. 
  63. Toews I, George AT, Peter JV, et al. Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units. Cochrane Database Syst Rev 2018;6:CD008687. 
  64. Ying VW, Kim SH, Khan KJ, et al. Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies. Surg Endosc 2015;29:1018-1023. 
  65. Biondetti P, Fumarola EM, Ierardi AM, et al. Bleeding complications after pancreatic surgery: interventional radiology management. Gland Surg 2019;8:150-163. 
  66. Roulin D, Cerantola Y, Demartines N, et al. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg 2011;15:1055-1062. 
  67. Nishikawa K, Fujita T, Yuda M, et al. Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy. Surgery 2016;160:1294-1301. 
  68. Okada T, Kawada K, Nakajima Y, et al. Internal pressure of the conduit during endoscopy on the day after esophagectomy. Dig Surg 2013;30:183-189. 
  69. Information Committee of the Korean Gastric Cancer Association. Korean Gastric Cancer Association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 2021;21:221-235. 
  70. Kim MC, Kim W, Kim HH, et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol 2008;15:2692-2700. 
  71. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg 2017;27:2279-2289. 
  72. Moreels TG, Hubens GJ, Ysebaert DK, et al. Diagnostic and therapeutic double-balloon enteroscopy after small bowel Roux-en-Y reconstructive surgery. Digestion 2009;80:141-147. 
  73. Souto-Rodriguez R, Alvarez-Sanchez MV. Endoluminal solutions to bariatric surgery complications: a review with a focus on technical aspects and results. World J Gastrointest Endosc 2017;9:105-126. 
  74. Tagaya N, Kasama K, Inamine S, et al. Evaluation of the excluded stomach by double-balloon endoscopy after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2007;17:1165-1170. 
  75. Sakai P, Kuga R, Safatle-Ribeiro AV, et al. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity?: the use of the double-balloon enteroscope. Endoscopy 2005;37:566-569. 
  76. McEvoy SH, Lavelle LP, Hoare SM, et al. Pancreaticoduodenectomy: expected post-operative anatomy and complications. Br J Radiol 2014;87:20140050. 
  77. Standop J, Schafer N, Overhaus M, et al. Endoscopic management of anastomotic hemorrhage from pancreatogastrostomy. Surg Endosc 2009;23:2005-2010.