Endoscopic management of early GI tract bleeding in a group 
of bariatric patients undergoing a fast track protocol

Michał Szymański; Iwona Marek; Andrzej Hellmann; Agastya Patel; Justyna Bigda; Łukasz Kaska; Monika Proczko-Stepaniak

doi:10.5114/wiitm.2020.99146

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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abstract:

Original paper

Endoscopic management of early GI tract bleeding in a group of bariatric patients undergoing a fast track protocol

Michał Szymański

¹

,

Iwona Marek

²

,

Andrzej Hellmann

¹

,

Agastya Patel

¹

,

Justyna Bigda

¹

,

Łukasz Kaska

¹

,

Monika Proczko-Stepaniak

¹

Department of General, Endocrine and Transplant Surgery, Faculty of Medicine Medical University of Gdansk, Gdansk, Poland
Department of Gastroenterology and Hepatology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland

Videosurgery Miniinv 2021; 16 (1): 139–144

DOI: https://doi.org/10.5114/wiitm.2020.99146

Online publish date: 2020/09/19

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Introduction
Enhanced recovery after bariatric surgery (ERABS) and other fast track protocols are currently being implemented in bariatric surgery. This approach has several benefits. However, early complications may occur and require urgent re-hospitalization and management. Gastrointestinal (GI) bleeding following bariatric surgery remains one of the most serious complications requiring endoscopic treatment.

Aim
To evaluate the potential influence of early endoscopic intervention on bariatric patients’ management.

Material and methods
A clinical database was searched for patients undergoing endoscopic treatment because of GI tract bleeding following bariatric surgery under the ERABS protocol. 14 out of 1431 patients operated on were identified and their data were extracted for the purposes of this study. Patients readmitted to the hospital due to developing GI tract bleeding (group 2) were compared with patients undergoing endoscopic intervention during the initial stay (group 1), for the same purpose.

Results
We found no statistically significant differences in hemoglobin level or length of hospital stay before endoscopy between groups. Based on the analyzed data, the percentage of GI bleeding in patients operated on under the ERABS protocol in our center is 0.97% (n = 14). The rate of early (up to 30 days) readmissions due to GI tract bleeding is 0.4% (n = 5) with an overall early readmission rate of 0.91% (n = 13) in the study period since the ERABS protocol was implemented.

Conclusions
Long-term effects (% total weight loss, %TWL) of bariatric surgery do not depend on the need of early endoscopic intervention and rehospitalization. Endoscopic intervention is a safe treatment modality, not associated with risk of reoperation or complications.

keywords:

Endoscopic management of early GI tract bleeding in a group of bariatric patients undergoing a fast track protocol

Michał Szymański 1 , Iwona Marek 2 , Andrzej Hellmann 1 , Agastya Patel 1 , Justyna Bigda 1 , Łukasz Kaska 1 , Monika Proczko-Stepaniak 1

obesity, endoscopy, enhanced recovery after bariatric surgery, enhanced recovery after surgery, gastrointestinal tract bleeding

Michał Szymański

¹

,

Iwona Marek

²

,

Andrzej Hellmann

¹

,

Agastya Patel

¹

,

Justyna Bigda

¹

,

Łukasz Kaska

¹

,

Monika Proczko-Stepaniak

¹