Aims
PostOperative GastroIntestinal Bleeding (POGIB) is a rare but relevant complication. Endoscopy represents a first-line treatment, but evidence about its safety and effectiveness remain limited. We aimed to report our experiences in the management of POGIB.
Methods
A retrospective analysis with prospectively collected data was conducted on all patients that underwent endoscopic procedure for suspected POGIB at our center between January 2019 and July 2025. Univariate analyses were performed to identify predictive factors for clinical success in anastomotic bleeding.
Results
Eighty-two patients (median age 65 years, IQR 58-75; 61% male) underwent endoscopy a median of 6 days after surgery (IQR 2-12) for suspected gastrointestinal bleeding (63% hematochezia, 27% melena, 5% hematemesis, 5% asymptomatic anemia). Active bleeding or stigmata were found in 83% of cases: 70% anastomotic, 13% non-anastomotic (mainly ulcerative gastroduodenitis). Hemostatic intervention was performed in 72% of patients, mainly mechanical (38%) or combined mechanical (27%). Technical success was achieved in 88%, overall clinical success in 82% (in 62 cases after one, in 5 after two endoscopic procedures). Ten patients underwent reoperation (five for persistent bleeding) and four died (one for massive gastrointestinal bleeding). Considering POGIB with anastomotic bleeding, no predictive factors for clinical success were identified among demographic or clinical data. Among treatments, mechanical hemostasis was significantly associated with higher success rates (p=0.0005). No adverse events occurred during endoscopy.
Tab 1: General characteristics of study population and main findings (n=82)
|
Previous gastrointestinal surgery n (%) |
23 (28) |
|
Department of admission n (%) |
Colorectal surgery 49 (60); Sarcoma/Mesenchyma surgery 15 (18); Hepatobiliary surgery 14 (17); Other 4 (5) |
|
Multivisceral surgery n (%) |
39 (48) |
|
Endoscopic procedures n (%) |
Colonoscopy 59 (72); EGDS 22 (27); Enteroscopy DAE 1 (1) |
|
Endoscopic treatments n (%) |
Mechanical 31 (38); Mechanical + topical 16 (20); Topical 6 (7); Mechanical + injection 4 (5); Mechanical + thermal 2 (2); No treatment 23 (28) |
EGDS: EsophagoGastroDuodenoScopy; DAE: Device Assisted Enteroscopy.
Tab 2. Univariate analysis of results of endoscopic treatments in anastomotic bleeding (n=57)
|
Variable |
Success / Failure |
P value |
|
Age |
– |
0.535 |
|
Sex |
Male 28/4, Female 24/1 |
0.513 |
|
Surgery and Timing |
Past GI surgery: No 42/5, Yes 10/0; Multivisceral: No 28/2, Yes 24/3; Anastomosis site: Upper 6/0, Lower 46/5; Endoscopy: ≤7days 36/3, >7days 16/2 |
0.642–1 |
|
Endoscopic treatments |
None 0/2, Mechanical 30/1, Mechanical+other 19/2, Topical 3/0 |
0.0057 |
Conclusions
Results suggest that endoscopic management of POGIB is safe and effective. Further prospective studies are needed to establish the best endoscopic strategy.