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Surgical Endoscopy

, Volume 31, Issue 8, pp 3210–3218 | Cite as

Clinical features of postoperative anastomotic bleeding after gastrectomy and efficacy of endoscopic hemostasis: a case–control study

  • Sunpyo Lee
  • Ji Yong Ahn
  • Shin Na
  • Hee Kyong Na
  • Kee Wook Jung
  • Do Hoon Kim
  • Jeong Hoon Lee
  • Kee Don Choi
  • Ho June Song
  • Gin Hyug Lee
  • Hwoon-Yong Jung
  • Seon-Ok Kim
Article

Abstract

Background

Postoperative anastomotic bleeding (PAB) is relatively rare; however, it can be lethal if not treated immediately. The aim of our study was to investigate the clinical features of PAB and the efficacy of endoscopic hemostasis (EH) for PAB.

Methods

Between January 2004 and May 2013, 16,591 patients underwent gastrectomy for gastric cancer at Asan Medical Center. Among them, 36 patients who experienced PAB within 2 months after the gastrectomy were enrolled as a case group. Each subject was matched at a ratio of 1:5 with randomly selected patients without bleeding during the same period (n = 180, control group). The clinical outcomes and risk factors for patients with PAB were compared with those of the control group, and the results of EH were evaluated retrospectively.

Results

The incidence of PAB was 0.22% (n = 36), and the median duration from gastrectomy to PAB was 34.5 h (interquartile range, 12.3–132.8 h). EH was attempted in 25 patients (69.4%); surgery was performed in 6 patients (16.7%); and conservative management was applied in 5 patients (13.9%). PAB-related death occurred in three patients (8.3%; one in each treatment modality). Among 25 patients with primary EH, 16 were treated successfully (64%) and hemoclip was the most commonly used endoscopic tool (52%). In the multivariate analysis, the type of gastrectomy was found to be a risk factor for PAB (odds ratio 3.448, 95% confidence interval, 1.138–10.448, p = .029).

Conclusions

Although PAB is an infrequent and potentially life-threatening complication, endoscopy can be considered as a useful method to avoid additional surgery in properly selected patients.

Keywords

Anastomosis Bleeding Endoscopy Gastrectomy 

Notes

Compliance with ethical standards

Disclosures

Sunpyo Lee, Ji Yong Ahn, Shin Na, Hee Kyong Na, Kee Wook Jung, Do Hoon Kim, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Seon-Ok Kim have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sunpyo Lee
    • 1
  • Ji Yong Ahn
    • 1
  • Shin Na
    • 1
  • Hee Kyong Na
    • 1
  • Kee Wook Jung
    • 1
  • Do Hoon Kim
    • 1
  • Jeong Hoon Lee
    • 1
  • Kee Don Choi
    • 1
  • Ho June Song
    • 1
  • Gin Hyug Lee
    • 1
  • Hwoon-Yong Jung
    • 1
  • Seon-Ok Kim
    • 2
  1. 1.Department of Gastroenterology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  2. 2.Department of Clinical Epidemiology and Biostatistics, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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