title: Endoscopic management of anastomotic hemorrhage from pancreatogastrostomy.
abstract: BACKGROUND
  Hemorrhage from pancreatic-enteric anastomosis after pancreaticoduodenectomy (PD) is a critical condition due to its difficult accessibility and delicate condition, and therefore remains a major challenge for the surgeon in charge.
  
  
  OBJECTIVE
  This study analyzed presentation and management of pancreatogastrostomy hemorrhage (PGH) after PD to determine the respective roles of endoscopy and surgery.
  
  
  METHODS
  Patients who underwent PD with pancreatogastrostomy between 1989 and January 2008 were identified from a pancreatic resection database and analyzed with regards to PGH, treatment strategy and outcome, and incidence of postoperative complications.
  
  
  RESULTS
  Out of 265 consecutive patients with PD, 10 patients (3.7%) experienced an episode of PGH, detected on average on postoperative day 5. No patient with PGH died during hospital stay as opposed to a mortality rate of 2.7% in patients without PGH. Morbidity rates were 50% versus 48% and length of hospital stay was 23 versus 21 days for patients with and without PGH, respectively, with no statistical differences between the groups. Endoscopic approach to control PGH was successful in nine patients. Pancreatogastrostomies were not compromised regarding procedure or air insufflations and no concomitant development of pancreatic fistula was observed. Open surgery was inevitable in one patient with recurrent PGH in order to achieve hemostasis, but resulted in pancreatic fistula and protracted hospital stay.
  
  
  CONCLUSIONS
  The present study demonstrates a feasible endoscopic approach for the management of PGH with high success rate and no concomitant procedure-related morbidity.
authors.affiliation: Department of Surgery, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany. standop@uni-bonn.de
authors.forename: Jens
authors.initials: J
authors.lastname: Standop
authors.forename: Nico
authors.initials: N
authors.lastname: Schäfer
authors.forename: Marcus
authors.initials: M
authors.lastname: Overhaus
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Lissie
authors.initials: L
authors.lastname: Ladwein
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirner
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005763:Gastroenterostomy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*