title: Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis.
abstract: BACKGROUND
  Gastrointestinal anastomoses may require early evaluation and treatment via flexible endoscopic techniques when complications arise. There is reticence, however, to perform endoscopy given the applied mechanical forces. We aimed to identify the incidence of gastrointestinal anastomotic perforation or disruption resulting from endoscopy performed ≤6 weeks of anastomoses.
  
  
  METHODS
  Review of patients from 2002 to 2013 who underwent flexible endoscopy within 6 weeks of creation of gastrointestinal anastomosis. Exclusion criteria included intraoperative endoscopy, anastomotic perforation prior to endoscopy, and endoscopy remote from the anastomotic site. Data are presented as median (interquartile range; IQR) or percentages as appropriate.
  
  
  RESULTS
  Twenty-four patients met our criteria (age 69 years [IQR 54-77], 54% men]). Endoscopy was performed at a median postoperative time of 18 days (IQR 8-30). Indications for endoscopy included bleeding (66%), obstruction (13%), pain (13%), concern for pancreatic duct leak (4%), and concern for ischemia (4%). Six patients underwent therapeutic endoscopic procedures including coagulation (8%), balloon dilation (8%), tube decompression (8%), and stent placement (4%). There were no anastomotic perforations or disruptions as a result of endoscopy.
  
  
  CONCLUSIONS
  Despite theoretical risks of adverse events of flexible endoscopy in the early postoperative period, no endoscopic perforations or disruptions occurred in recently created surgical anastomoses.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care and General Surgery, Mary Brigh 2-810, St. Mary's Hospital, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55902, USA.
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Amr
authors.forename: Mohammad J
authors.initials: MJ
authors.lastname: Alzghari
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Khasawneh
authors.forename: David S
authors.initials: DS
authors.lastname: Morris
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D061214:Patient Safety; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012812:Sigmoidoscopy / Q000379:methods; D016896:Treatment Outcome