TY - JOUR
T1 - Endoscopic Suturing for Massively Bleeding Marginal Ulcer 10 days Post Roux-en-Y Gastric Bypass
AU - Barola, Sindhu
AU - Magnuson, Thomas
AU - Schweitzer, Michael A
AU - Chen, Yen I.
AU - Ngamruengphong, Saowanee
AU - Khashab, Mouen
AU - Kumbhari, Vivek
PY - 2017/2/28
Y1 - 2017/2/28
N2 - Background: Marginal ulceration post Roux-en-Y gastric bypass (RYGB) with associated bleeding, although infrequently encountered, can be challenging to treat. Flexible endoscopic therapy is preferred over surgery due to its minimally invasive nature. Bleeding ulcers have traditionally been treated endoscopically by injecting epinephrine, bipolar hemostasis, or clips. Here, we describe our treatment with endoscopic suturing for a massively bleeding marginal ulcer after RYGB. Methods: A 56-year-old female 10 days post RYGB underwent her fourth endoscopy for investigation and management of hematemesis and was found to have a large bleeding anastomotic ulcer. A Rothnet was utilized to remove large blood clots which obstructed endoscopic visualization. Two marginal ulcers were noted, and these were successfully oversewn with endoscopic suturing. The multimedia video (7 min) demonstrates the management of massively bleeding marginal ulcer after RYGB by endoscopic suturing. Results: Patient had no further bleeding and tolerated diet the subsequent day. She was discharged home with no further episodes of hematemesis, and follow-up at 6 weeks showed well-healed ulcer on endoscopy. Conclusion: Endoscopic suturing of a bleeding marginal ulcer appears technically feasible and safe. It should be considered in the treatment algorithm prior to emergency surgery.
AB - Background: Marginal ulceration post Roux-en-Y gastric bypass (RYGB) with associated bleeding, although infrequently encountered, can be challenging to treat. Flexible endoscopic therapy is preferred over surgery due to its minimally invasive nature. Bleeding ulcers have traditionally been treated endoscopically by injecting epinephrine, bipolar hemostasis, or clips. Here, we describe our treatment with endoscopic suturing for a massively bleeding marginal ulcer after RYGB. Methods: A 56-year-old female 10 days post RYGB underwent her fourth endoscopy for investigation and management of hematemesis and was found to have a large bleeding anastomotic ulcer. A Rothnet was utilized to remove large blood clots which obstructed endoscopic visualization. Two marginal ulcers were noted, and these were successfully oversewn with endoscopic suturing. The multimedia video (7 min) demonstrates the management of massively bleeding marginal ulcer after RYGB by endoscopic suturing. Results: Patient had no further bleeding and tolerated diet the subsequent day. She was discharged home with no further episodes of hematemesis, and follow-up at 6 weeks showed well-healed ulcer on endoscopy. Conclusion: Endoscopic suturing of a bleeding marginal ulcer appears technically feasible and safe. It should be considered in the treatment algorithm prior to emergency surgery.
KW - Endoscopic suturing
KW - Epinephrine
KW - Hematemesis
KW - Marginal ulcer
KW - Roux-en-Y gastric bypass
UR - http://www.scopus.com/inward/record.url?scp=85014050322&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014050322&partnerID=8YFLogxK
U2 - 10.1007/s11695-017-2621-x
DO - 10.1007/s11695-017-2621-x
M3 - Article
C2 - 28247322
AN - SCOPUS:85014050322
SN - 0960-8923
SP - 1
EP - 3
JO - Obesity Surgery
JF - Obesity Surgery
ER -