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Endoscopic Management of Early Upper Gastrointestinal Hemorrhage Following Laparoscopic Roux-En-Y Gastric Bypass

Jamil, Laith H., M.D.1; Krause, Kevin R., M.D.2; Chengelis, David L., M.D.2; Jury, Robert P., M.D.2; Jackson, Clara M., M.D., Ph.D.3; Cannon, Michael E., M.D.1; Duffy, Michael C., M.D.1

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 86–91
ORIGINAL CONTRIBUTIONS: ENDOSCOPY
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BACKGROUND AND AIMS 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.

METHODS Retrospective chart review of all patients who developed UGIH following LRYGB from November 2001 to July 2005 at a large suburban teaching hospital.

RESULTS 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).

CONCLUSIONS (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.

1Division of Gastroenterology/Hepatology, 2Department of Surgery, 3Department of Medicine/Pediatrics, William Beaumont Hospital, Royal Oak, Michigan

Reprint requests and correspondence: Laith H. Jamil, M.D., Mayo Clinic Jacksonville, Division of Gastroenterology, Davis Bldg 6A, 4500 San Pablo Rd., Jacksonville, FL 32224.

Received April 29, 2007; accepted August 21, 2007.

CONFLICT OF INTERESTGuarantor of the article: Michael C. Duffy, M.D.

Specific author contributions: Laith H. Jamil: data collection, data analysis, data entry, manuscript preparation, literature review. Kevin R. Krause: patient contribution, manuscript preparation and review. David L. Chengalis: patient contribution, manuscript preparation and review. Robert P. Jury: patient contribution, manuscript preparation and review. Clara M. Jackson: literature review, data entry, data analysis, manuscript preparation and review. Michael E. Cannon: patient contribution, manuscript preparation and review. Michael C. Duffy: mentor, patient contribution, manuscript preparation and review.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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