title: Endoscopic hemostasis using endoclip in early gastrointestinal hemorrhage after gastric bypass surgery.
abstract: Roux-en-Y gastric bypass (RYGBP) is the most commonly performed bariatric operation in the USA. In the early postoperative stage, gastrointestinal (GI) bleeding is an infrequent but potentially serious complication that usually results from bleeding at the gastrojejunostomy staple-line. Observant management with transfusion for stable patients and surgical exploration for unstable patients is typically recommended for early GI bleeding. We hypothesized that use of endoclips, which do not cause thermal injury to the surrounding tissues (or anastomosis), may be preferable to thermal approaches which could cause tissue injury. We report 2 cases of early GI bleeding after RYGBP that were successfully managed with endoclip application to bleeding lesions. Emergent endoscopy was performed, and major stigmata such as active spurting vessel and adherent clot were noted at the gastrojejunostomy staple-lines. Endoscopic hemostasis using endoclips was readily applied to bleeding lesions at staple-lines. Primary hemostasis was achieved, and there was no recurrent bleeding or complication. We conclude that therapeutic endoscopy can be performed safely for early bleeding after RYGBP. In patients with early bleeding after RYGBP, use of endoclips is mechanistically preferable to other options.
authors: Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390-8887, USA. shou-jiang.tang@utsouthwestern.edu
authors: Shou-Jiang
authors: SJ
authors: Tang
authors: Homero
authors: H
authors: Rivas
authors: Linda
authors: L
authors: Tang
authors: Luis F
authors: LF
authors: Lara
authors: Jayaprakash
authors: J
authors: Sreenarasimhaiah
authors: Don C
authors: DC
authors: Rockey
mesh_terms: D000328:Adult; D000465:Algorithms; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D013997:Time Factors