title: Endoscopic treatment and risk factors of postoperative anastomotic bleeding after gastrectomy for gastric cancer.
abstract: BACKGROUND
  Anastomotic leakage, bleeding, and stricture are major complications after gastrectomy. Of these complications, postoperative anastomotic bleeding is relatively rare, but lethal if not treated immediately.
  
  
  METHODS
  Of 2031 patients with gastric cancer who underwent radical gastrectomy (R0 resection) between January 2002 and December 2010, postoperative anastomotic bleeding was observed in 7 patients. The clinicopathological features, postoperative outcomes such as surgical procedures, bleeding sites and, methods used to achieve hemostasis, and the risk factors of anastomotic bleeding of these 7 patients were analyzed.
  
  
  RESULTS
  Of the 2031 patients, 1613 and 418 underwent distal and total gastrectomy, respectively. The bleeding sites were as follows: Billroth-I anastomosis using a circular stapler (n = 1), Billroth-II anastomosis by manual suture (n = 5), and esophagojejunostomy using a circular stapler (n = 1). All patients were treated with endoscopic clipping or epinephrine injection. There was no further endoscopic intervention or reoperation for anastomotic bleeding.
  
  
  CONCLUSIONS
  Postoperative anastomotic bleeding is an infrequent but potentially life-threatening complication. Scrupulous surgical procedures are essential for the prevention of postoperative bleeding, and endoscopy was useful for both the confirmation of bleeding and therapeutic intervention.
authors.affiliation: Department of Surgery, Dong-A University, College of Medicine, Seo-Gu, Busan, Republic of Korea.
authors.forename: Ki-Han
authors.initials: KH
authors.lastname: Kim
authors.forename: Min-Chan
authors.initials: MC
authors.lastname: Kim
authors.forename: Ghap-Joong
authors.initials: GJ
authors.lastname: Jung
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Jang
authors.forename: Seok-Ryeol
authors.initials: SR
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome