title: Emergency endoscopy for gastrointestinal bleeding after bariatric surgery. Therapeutic algorithm.
abstract: OBJECTIVE
  Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm.
  
  
  METHODS
  From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy.
  
  
  RESULTS
  Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively.
  
  
  CONCLUSIONS
  Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España. Electronic address: mlgrgr@gmail.com.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: García-García
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España.
authors.forename: Juan Gervasio
authors.initials: JG
authors.lastname: Martín-Lorenzo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Torralba-Martínez
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España.
authors.forename: Ramón
authors.initials: R
authors.lastname: Lirón-Ruiz
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España.
authors.forename: Joana
authors.initials: J
authors.lastname: Miguel Perelló
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España.
authors.forename: Benito
authors.initials: B
authors.lastname: Flores Pastor
authors.affiliation: Sección de Gastroenterología y Endoscopia, Hospital Universitario J. M. Morales Meseguer, Murcia, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez Cuadrado
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario J. M. Morales Meseguer, Murcia, España; Departamento de Cirugía, Campus de Excelencia Internacional «Campus Mare Nostrum», Universidad de Murcia, Murcia, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Aguayo Albasini
mesh_terms: D000328:Adult; D000465:Algorithms; D050110:Bariatric Surgery / Q000009:adverse effects*; D004638:Emergency Treatment; D015390:Gastric Bypass / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011446:Prospective Studies
keywords: Bariatric surgery; Bypass gástrico laparoscópico; Cirugía bariátrica; Complicaciones postoperatorias; Complications; Gastrointestinal bleeding; Hemorragia gastrointestinal; Laparoscopic gastric bypass; Morbid obesity; Obesidad mórbida; Tratamiento; Treatment