Endoscopia urgente por hemorragia digestiva tras cirugía bariátrica. Algoritmo terapéutico

García-García, María Luisa; Martín-Lorenzo, Juan Gervasio; Torralba-Martínez, José Antonio; Lirón-Ruíz, Ramón; Perelló, Joana Miguel; Pastor, Benito Flores; Cuadrado, E. Pérez; Albasini, José Luis Aguayo

doi:10.1016/j.ciresp.2014.05.002

Cited by 14 publications

(8 citation statements)

References 16 publications

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“…Failed endoscopic therapy of upper gastrointestinal bleeding requires a cooperative approach of the surgeon, interventional radiologist and endoscopist [ 37 ]. The place for IOG is in massive bleeding disabling the localization of the bleeding (fundal varices, Dieulafoy ulcer [ 38 ], angiodysplasia [ 39 ], esophagocardial junction bleeding, bleeding from post-duodenal location) or in postoperative bleeding (post-pancreatectomy bleeding [ 40 , 41 ], esophageal conduit bleeding, bleeding after fundoplication, sleeve gastrectomy [ 42 ] etc.). Gastroscopy without identification of the specific bleeding lesion may continue with intraoperative enteroscopy [ 43 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Indications and benefits of intraoperative esophagogastroduodenoscopy.

Stašek

Aujeský

Vrba

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionIntraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy.AimTo evaluate the indications, benefits and risks of IOG.Material and methodsA single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed.ResultsThe cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG.ConclusionsThe IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.

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Section: Discussionmentioning

confidence: 99%

Indications and benefits of intraoperative esophagogastroduodenoscopy.

Stašek

Aujeský

Vrba

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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“…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 [ 7 ]. To date, there is no consensus about the endoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

“…Upper endoscopy is frequently used only in late postoperative bleeding due to the high risk of dehiscence and perforation associated with its use in the early postoperative period. Therefore, upper endoscopy is only considered in cases of rebleeding after conservative management or in patients who present with hemodynamic instability [ 7 ].…”

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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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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“…However, our results concur with the higher incidence of GIB known to occur in patients undergoing metabolic surgery likely related to suture dehiscence and ulcers or anticoagulation for thromboprophylaxis. 38 , 39 , 40 Aggressive noninvasive strategies for obesity control initiated at a younger age could provide benefits in adult life by preventing cardiovascular diseases including AF and HF. 41 , 42 …”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery to aLleviate OCcurrence of Atrial Fibrillation Hospitalization—BLOC-AF

et al. 2020

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Background Obesity is associated with a higher incidence of atrial fibrillation (AF). Weight reduction improves outcomes in patients known to have AF. Objective The purpose of this study was to compare the incidence of heart failure (HF) or first-time AF hospitalization in obese patients undergoing bariatric surgery (BAS) vs other abdominal surgeries. Methods A retrospective cohort study was conducted using linked hospital discharge records from 1994–2014. Obese patients without known AF or atrial flutter (AFL) who had undergone abdominal hernia or laparoscopic cholecystectomy surgery were identified for each case that underwent BAS (2:1). Clinical outcomes were HF, first-time hospitalization for AF, AFL, gastrointestinal bleeding (GIB), and ischemic or hemorrhagic stroke. Outcomes were analyzed using conditional proportional hazard modeling accounting for the competing risk of death, adjusting for demographics and comorbidities. Results There were 1581 BAS cases and 3162 controls (48% age <50 years; 60% white; 79% female; mean CHA 2 DS 2 VASc score 1.6 ± 1.2) with follow-up of 66 months. Compared to controls, BAS cases had a significantly lower risk of new-onset AF (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.54–0.93) or HF (HR 0.74; 95% CI 0.60–0.91) but a higher risk of GIB (HR 2.1; 95% CI 1.5–3.0), with no differences in AFL, ischemic stroke, or hemorrhagic stroke. Reduction in AF improved as follow-up increased beyond 60 months. Conclusion In patients undergoing BAS, the risk of either HF or AF was reduced by ∼29% but with greater risk of GIB. The findings support the hypothesis that weight loss reduces the long-term risk of HF or incident AF hospitalization.

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Endoscopia urgente por hemorragia digestiva tras cirugía bariátrica. Algoritmo terapéutico

Cited by 14 publications

References 16 publications

Indications and benefits of intraoperative esophagogastroduodenoscopy.

Indications and benefits of intraoperative esophagogastroduodenoscopy.

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

Bariatric surgery to aLleviate OCcurrence of Atrial Fibrillation Hospitalization—BLOC-AF

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