Delayed Massive Bleeding Two Years After Roux-en-Y Gastric Bypass

Coblijn, Usha K.; Lagarde, Sjoerd M.; Tuynman, Jurriaan B.; Meyel, Juup J M van; Wagensveld, Bart A. van

doi:10.4293/108680813x13693422518470

Cited by 6 publications

(12 citation statements)

References 34 publications

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“…Marginal ulcers in anastomosis sites are the most common cause of late bleeding in bypassed patients. 6 In addition, a tense anastomosis favors microvascular ischemia and neovascularization, which increases the risk of bleeding. Peptic ulcers in the gastric remnant can also be a late cause of bleeding as these patients are susceptible to several risk factors for peptic disease, such as Helicobacter pylori (H. pylori) infection, use of NSAIDs, smoking, and preserved acid secretion in the gastric pouch.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the occasional passage of non-absorbable sutures into the lumen favors the formation of ulcers. 4,6 These events constitute a complex scenario especially when upper and lower endoscopic examinations do not identify the source of bleeding. Bleeding from the excluded segments is a rare phenomenon, and while there are no specific clinical guidelines available, several management algorithms have been proposed.…”

Section: Discussionmentioning

confidence: 99%

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Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report

et al. 2021

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The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory. Clin Endosc 2021 May 25.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report

et al. 2021

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“…Marginal ulcers comprise the vast majority of gastrointestinal bleeding complications in patients who have undergone a RYGB, with an estimated incidence of 0.6%-16%[ 4 ]. Marginal ulcers are easily diagnosed and treated with conventional upper endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report

Zarrin

Sorathia

Choksi

et al. 2020

WJGE

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BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery. Furthermore, acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously. Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach. Traditionally, this necessitates surgical intervention. Recently, however, the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management. CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension, nausea, and melena of two days duration. His imaging illustrated a massively distended stomach. A nasogastric tube did not result in drainage of fluid or decompression of his abdomen. His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended "fluid"-filled gastric remnant. An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant. Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum. The patient underwent emergent angiography with embolization of the gastroduodenal artery. He was discharged with a stable hemoglobin level and resolution of symptoms. Healing superficial gastric ulcers were visualized on a follow-up endoscopy. Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated, and successful eradication was achieved. CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound-directed transgastric intervention.

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“…Azagury et al reportaron tasas de curación de 68% con terapia médica supresora de ácido+sucralfato, en adición a la eliminación de las sustancias incitantes 25 . La erosión de la úlcera dentro de un vaso subyacente se presenta con hematemesis, hematoquecia y signos de hipovolemia, lo que demanda la terapia endoscópica inmediata realizada por un endoscopista con experiencia 26 . Otras causas más extrañas se muestran en la tabla 2 11,27,28 .…”

Section: Hemorragia Tardíaunclassified

Endoscopía luego de cirugía bariátrica: Lo que debe saber el endoscopista

Díaz¹,

Narvaez

Welsh

et al. 2020

Rev. méd. Chile

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Endoscopy after bariatric surgery: what the endoscopist must know Endoscopy is essential in the assessment and treatment of the bariatric patient, especially in the postoperative state. Since bariatric surgery is increasing exponentially, endoscopists should be familiar with the anatomy and how to manage possible complications. New less invasive therapeutic tools will have a major impact on the prognosis of these patients. Dreaded complications such as leaks, stenosis or weight regain can be successfully assessed and treated by endoscopy. Postoperative evaluation of symptoms requires the precise search of details that can change patient's management.

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Delayed Massive Bleeding Two Years After Roux-en-Y Gastric Bypass

Abstract: Delayed massive bleeding from an ischemic ulcer after Roux-en-Y gastric bypass is a rare and challenging event for the gastroenterologist as well as the bariatric surgeon.

Cited by 6 publications

References 34 publications

Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report

Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report

Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report

Endoscopía luego de cirugía bariátrica: Lo que debe saber el endoscopista

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