Water-immersion sigmoidoscopy to treat acute GI bleeding in the perioperative period after surgical colorectal anastomosis
Received 27 May 2009; accepted 9 July 2009. published online 19 October 2009.
Background
The occurrence of lower acute GI bleeding in the early perioperative period after colorectal anastomosis represents a life-threatening condition. The early treatment includes surgery or endoscopy, the latter being subject to complications associated with air insufflation and associated perforation.
Objective
To study the feasibility, efficacy, and safety of early perioperative water-immersion endoscopy to treat the source of bleeding in patients having undergone colorectal anastomosis.
Design
To prospectively study patients with active lower GI bleeding early after colorectal anastomosis and subject them to therapeutic water-immersion endoscopy instead of surgery.
Setting
University referral center for digestive surgery and endoscopy.
Patients
This study involved 2 patients presenting with active lower GI bleeding within 4 days after colorectal surgery.
Intervention
Instead of air insufflation during endoscopy, an underwater investigation was performed in each patient after colonic water immersion.
Main Outcome Measurements
Efficacy of therapeutic endoscopy.
Results
Water-immersion endoscopy in each case allowed us to identify the location of the anastomosis and the source of active bleeding. It allowed us to safely place clips on the active vessels and stop the bleeding.
Limitations
Number of patients included, no comparison between conventional endoscopy and water-immersion endoscopy.
Conclusion
Diagnostic as well as therapeutic water-immersion colonoscopy is safe in patients presenting with active lower GI bleeding in the early perioperative period after colorectal anastomosis.
Geneva, Switzerland
Current affiliations: Service of Gastroenterology (J.-L.F.), Service of Digestive Surgery (P.G., O.H.), Geneva University Hospital, Geneva, Switzerland
Reprint requests: Jean-Louis Frossard, Service of Gastroenterology, Geneva University Hospitals, Rue Micheli du Crest, 1211 Genève 14, Switzerland.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Frossard at jean-louis.frossard@hcuge.ch.
ABSTRACT