Endoscopic management of postoperative anastomotic bleeding in patients with colorectal cancer

Liu, Wei; Lin, Dezheng; Zhong, Qinghua; Su, Mingli; Li, Juan; Guo, Xuefeng; Hu, Jiancong

doi:10.1007/s00384-020-03614-x

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Factors affecting these in our patient, including the duration of surgery, hypovolemic shock, and high ligation of the inferior mesenteric artery, could have been relevant [7,9,10]; this patient underwent a right hemihepatectomy for liver metastasis at the time of colorectal anastomosis, with a total When luminal bleeding occurs, endoscopic treatment options include injection therapy, thermal coagulation, and clipping [11]. Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [6,11]. APC allows noncontact endoscopic thermal coagulation by delivering a high-frequency electrical current through emitted argon gas; however, its cost is higher than the other modalities, and its use for larger vessels is still controversial [11].…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, air insufflation during endoscopy could delay the anastomotic healing process; however, endoscopy safety was demonstrated in patients with gastrointestinal [ 4 ] and colorectal [ 6 ] anastomoses during the early postoperative period. In this study, anastomotic leakage occurred in 1 of the 9 patients.…”

Section: Discussionmentioning

confidence: 99%

“…When luminal bleeding occurs, endoscopic treatment options include injection therapy, thermal coagulation, and clipping [ 11 ]. Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [ 6 , 11 ]. APC allows noncontact endoscopic thermal coagulation by delivering a high-frequency electrical current through emitted argon gas; however, its cost is higher than the other modalities, and its use for larger vessels is still controversial [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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

Han

Park

et al. 2022

Ann Coloproctol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Han

Park

et al. 2022

Ann Coloproctol

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“…The rate of therapeutic effectiveness of colonoscopy is almost 81% being good prognostic factors the use of hemoclips and bleeding within the first 5 days after surgery. No correlation has been reported between early colonoscopy and the development of anastomotic dehiscence 2 .…”

Section: Cirugia Y Cirujanos (Eng)mentioning

confidence: 99%

Colonoscopy as a therapeutic option for acute after sigmoidectomy rectal bleeding

Moreno-Navas,

Gómez-Luque,

Díaz-López

et al. 2024

CIRUE

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Comparative retrospective study on surgical outcomes of hand‐sewn anastomosis versus stapling anastomosis for colectomy using a nationwide inpatient database in Japan with propensity score matching

Ebinuma,

Kunisawa,

Fushimi

et al. 2024

Annals of Gastroent Surgery

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BackgroundIntestinal anastomosis is performed by two main methods: hand‐sewn anastomosis (HA) and stapling anastomosis (SA). Studies on anastomosis are still being reported and are an ongoing area of interest. The aim of this study was to evaluate the characteristics of each by comparing them with description and statistical analysis using a nationwide inpatient database.MethodsWe collected data for colon cancer patients who underwent colectomy between April 2014 and March 2022 using the Diagnosis Procedure Combination (DPC) database. In the descriptive analysis, we described the background of the study population and the number of each method. In the statistical analysis, we used propensity score matching to achieve balanced covariates and showed the results of the comparative study using risk ratios and risk differences.ResultsA total of 232 155 cases were selected (HA group: 40 764; SA group: 191 391). SA was performed more frequently than HA during the study period, with the proportion of SA increasing over the last few years (~80% in 2015 and 85% in 2021). We obtained 40 760 pairs through propensity score matching. The comparison of postoperative events varied by outcome (reoperation: 517 [1.27%] vs 380 [0.93%]; risk ratio [RR]: 1.36 [95% confidence interval [CI], 1.19 to 1.55], endoscopic intestinal hemostasis: 17 [0.04%] vs 80 [0.20%]; RR: 0.21 [95% CI, 0.13 to 0.36]).ConclusionSA is becoming more common in colectomy. The risk of reoperation could be higher in the HA group, while the risk of postoperative endoscopic intestinal hemostasis could be higher in the SA group.

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Endoscopic management of postoperative anastomotic bleeding in patients with colorectal cancer

Cited by 4 publications

References 19 publications

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

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

Colonoscopy as a therapeutic option for acute after sigmoidectomy rectal bleeding

Comparative retrospective study on surgical outcomes of hand‐sewn anastomosis versus stapling anastomosis for colectomy using a nationwide inpatient database in Japan with propensity score matching

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