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Review
. 2023 Nov 2;59(11):1941.
doi: 10.3390/medicina59111941.

Endoscopic Management of Bleeding in Altered Anatomy after Upper Gastrointestinal Surgery

Giulia Gibiino  1 , Cecilia Binda  1 , Matteo Secco  1 , Paolo Giuffrida  1 , Chiara Coluccio  1 , Barbara Perini  1   2 , Stefano Fabbri  1 , Elisa Liverani  1 , Carlo Felix Maria Jung  1 , Carlo Fabbri  1
Affiliations
Review

Endoscopic Management of Bleeding in Altered Anatomy after Upper Gastrointestinal Surgery

Giulia Gibiino et al. Medicina (Kaunas). .

Abstract

Postoperative non variceal upper gastrointestinal haemorrhage may occur early or late and affect a variable percentage of patients-up to about 2%. Most cases of intraluminal bleeding are an indication for urgent Esophagogastroduodenoscopy (EGD) and require endoscopic haemostatic treatment. In addition to the approach usually adopted in non-variceal upper haemorrhages, these cases may be burdened with difficulties in terms of anastomotic tissue, angled positions, and the risk of further complications. There is also extreme variability related to the type of surgery performed, in the context of oncological disease or bariatric surgery. At the same time, the world of haemostatic devices available in digestive endoscopy is increasing, meeting high efficacy rates and attempting to treat even the most complex cases. Our narrative review summarises the current evidence in terms of different approaches to endoscopic haemostasis in upper bleeding in altered anatomy after surgery, proposing an up-to-date guidance for endoscopic clinicians and at the same time, highlighting areas of future scientific research.

Keywords: altered anatomy; anastomotic bleeding; bariatric surgery; endoscopic therapy; marginal ulcers; non-variceal upper gastrointestinal haemorrhage (NVUGIH).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for the diagnostic management of bleeding in patients with surgically altered anatomy.
Figure 2
Figure 2
Proposed flowchart showing the possible endoscopic approach in the treatment of bleeding.
See this image and copyright information in PMC

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