Efficacy and Safety of Endoscopic Clipping for Acute Anastomotic Bleeding After Colorectal Surgery

Abstract

Purpose: Anastomotic bleeding after colorectal surgery is a rare, mostly self-limiting, postoperative complication that could lead to a life-threatening condition. Therefore, prompt management is required. This study aimed to evaluate the efficacy and safety of endoscopic clipping for acute anastomotic bleeding after colorectal surgery. Methods: We retrospectively reviewed the data of patients pathologically diagnosed with colorectal cancer at National Cancer Center, Korea from January 2018 to November 2020, which presented with anastomotic bleeding within the first postoperative week and were endoscopically managed with clips. Results: Nine patients had anastomotic bleeding, underwent endoscopic management, and, therefore, were included in this study. All patients underwent laparoscopic (low/ultralow) anterior resection with mechanical double-stapled anastomosis. Anastomotic bleeding was successfully managed through a colonoscopy with clips on the first trial in all patients. Hypovolemic shock occurred in one patient, following anastomotic breakdown. Conclusion: Endoscopic clipping seems to be an effective and safe treatment for anastomotic bleeding with minimal physiologic stress, easy accessibility, and scarce postoperative complications. However, a surgical backup should always be considered for massive bleeding.

Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications

“…Postoperative bleeding is a rare but potentially fatal complication. The overall risk is around 6%, and in 1% of cases it may manifest as massive hemorrhage and hemodynamic instability [ 63 , 64 ]. During surgery, a presacral fascia injury or avulsion of the rectosacral fascia could damage the presacral and basivertebral veins, causing bleeding that is difficult to manage with conventional hemostatic maneuvers [ 65 ].…”

Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery

“…Intraoperative endoscopy has been used to evaluate the integrity of anastomoses, enabling the identification of bleeding at the anastomotic level or disruption of the anastomosis during surgery [36]. Endoscopy may also manage anastomotic bleeding, as it can be employed in a postoperative setting [37]. A systematic review and meta-analysis of six studies revealed that intraoperative endoscopy was linked with a decrease in postoperative AL (from 6.9% to 3.5%; OR=0.37; 95% CI, 0.21−0.68; P=0.001) and anastomotic bleeding (from 5.8% to 2.4%; OR=0.35; 95% CI, 0.15−0.82; P=0.02) in left-sided colon resection [36].…”