Endoscopic Management of Early Upper Gastrointestinal Hemorrhage Following Laparoscopic Roux-En-Y Gastric Bypass
| Autor: | Kevin R. Krause, Laith H. Jamil, Robert P Jury, Michael C. Duffy, David L. Chengelis, Clara M Jackson, Michael Cannon |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Gastrointestinal bleeding Gastric Bypass Postoperative Hemorrhage Endoscopic management digestive system health services administration medicine Humans Upper gastrointestinal Obesity Derivation Laparoscopy Retrospective Studies Hepatology medicine.diagnostic_test business.industry Stomach Hemostasis Endoscopic Suture Techniques Gastroenterology nutritional and metabolic diseases Length of Stay Middle Aged medicine.disease Roux-en-Y anastomosis humanities Endoscopy Surgery Treatment Outcome surgical procedures operative medicine.anatomical_structure Female Gastrointestinal Hemorrhage business Follow-Up Studies |
| Zdroj: | The American Journal of Gastroenterology. 103:86-91 |
| ISSN: | 1572-0241 0002-9270 |
| DOI: | 10.1111/j.1572-0241.2007.01588.x |
| Popis: | Upper gastrointestinal hemorrhage (UGIH) is an infrequent complication (1-3.8%) following laparoscopic Roux-en-Y gastric bypass (LRYGB). The safety and efficacy of endoscopic management of immediate postoperative bleeding is unknown. We sought to determine how frequently UGIH complicates LRYGB and whether endoscopic management is successful in controlling hemorrhage.Retrospective chart review of all patients who developed UGIH following LRYGB from November 2001 to July 2005 at a large suburban teaching hospital.Of 933 patients who underwent LRYGB, 30 (3.2%) developed postoperative UGIH. An endoscopic esophagogastroduodenoscopy (EGD) was performed in 27/30 patients (90%). All were found to have bleeding emanating from the gastrojejunostomy (GJ) staple line. Endoscopic intervention was performed in 24/30 (80%) with epinephrine injection and heater probe cautery being used most commonly. Endoscopic therapy was ultimately successful in controlling all hemorrhage, with 5 patients (17%) requiring a second EGD for rebleeding. No patient required surgery to control hemorrhage. One patient aspirated during the endoscopic procedure with subsequent anoxic encephalopathy and died 5 days postoperatively. Twenty-one patients (70%) developed UGIH in the intraoperative or immediate postoperative period (4 h postoperative). The mean length of stay was significantly longer in these patients (2.84 vs 4.1, P= 0.001).(a) UGIH complicates LRYGB in a small but significant number of patients. (b) Bleeding usually occurs at the GJ site. (c) EGD is safe and effective in controlling hemorrhage with standard endoscopic techniques. (d) UGIH occurs most commonly in the immediate postoperative period and may be best managed in the operating room with the patient intubated to prevent aspiration. |
| Databáze: | OpenAIRE |
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