title: Water-immersion sigmoidoscopy to treat acute GI bleeding in the perioperative period after surgical colorectal anastomosis.
abstract: 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.
  
  
  METHODS
  To prospectively study patients with active lower GI bleeding early after colorectal anastomosis and subject them to therapeutic water-immersion endoscopy instead of surgery.
  
  
  METHODS
  University referral center for digestive surgery and endoscopy.
  
  
  METHODS
  This study involved 2 patients presenting with active lower GI bleeding within 4 days after colorectal surgery.
  
  
  METHODS
  Instead of air insufflation during endoscopy, an underwater investigation was performed in each patient after colonic water immersion.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Number of patients included, no comparison between conventional endoscopy and water-immersion endoscopy.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service of Gastroenterology, Geneva University Hospital, Geneva, Switzerland. jean-louis.frossard@hcuge.ch
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Frossard
authors.forename: Pascal
authors.initials: P
authors.lastname: Gervaz
authors.forename: Olivier
authors.initials: O
authors.lastname: Huber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects*; D005240:Feasibility Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D019990:Perioperative Care; D011446:Prospective Studies; D012811:Sigmoid Neoplasms / Q000601:surgery*; D012812:Sigmoidoscopy / Q000379:methods*; D016896:Treatment Outcome