Endoscopic management of early GI hemorrhage after laparoscopic gastric bypass

Background

Early upper GI hemorrhage (UGH) is a potential complication after laparoscopic Roux-en-Y gastric bypass (RYGBP), and early reoperative intervention is the most accepted treatment. Experience with endoscopic treatment is limited.

Objective

Our purpose was to describe the role of endoscopy and injection therapy in the management of early UGH after laparoscopic RYGBP.

Design

Case series study.

Setting

Endoscopy Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.

Patients

We describe the endoscopic treatment of 6 patients with early UGH within 24 hours after a RYGBP.

Instrumentation

Upper endoscopy was performed in all 6 cases. The origin of the bleeding was identified at the staple line in all cases, and epinephrine alone or combined with polidocanol was successfully injected in 5 of 6 patients.

Results

Endoscopic therapy arrested active bleeding without any complications in all cases without the need for further surgery or endoscopic treatments.

Limitation

Our experience is limited to 6 cases.

Conclusion

Early postoperative UGH after RYGBP may be adequately controlled with endoscopic treatment and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.

Abbreviations: RYGBP, Roux-en-Y gastric bypass, UGH, upper GI hemorrhage