Water-immersion sigmoidoscopy to treat acute GI bleeding in the perioperative period after surgical colorectal anastomosis

• Published in: Gastrointestinal endoscopy Vol. 71; no. 1; pp. 167 - 170
• Main Authors: Frossard, Jean-Louis, Gervaz, Pascal, Huber, Olivier
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 2010; Elsevier
• Subjects: Aged; Aged, 80 and over; Anastomosis, Surgical - adverse effects; Biological and medical sciences; Colectomy - adverse effects; Digestive system. Abdomen; Endoscopy; Feasibility Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Humans; Intestinal Fistula - surgery; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Other diseases. Semiology; Perioperative Care; Prospective Studies; Sigmoid Neoplasms - surgery; Sigmoidoscopy - methods; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Water; Sigmoidoscopy; Treatment; Colorectal anastomosis; Gastrointestinal bleeding; Surgery; Acute; Surgical anastomosis; Digestive diseases; Intestinal disease; Colon; Immersion
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2009.07.018

The occurrence of lower acute GI bleeding in the early perioperative period after colorectal anastomosis represents a life-threatening condition. The early treatment includes surgery or endoscopy, the latter being subject to complications associated with air insufflation and associated perforation. To study the feasibility, efficacy, and safety of early perioperative water-immersion endoscopy to treat the source of bleeding in patients having undergone colorectal anastomosis. To prospectively study patients with active lower GI bleeding early after colorectal anastomosis and subject them to therapeutic water-immersion endoscopy instead of surgery. University referral center for digestive surgery and endoscopy. This study involved 2 patients presenting with active lower GI bleeding within 4 days after colorectal surgery. Instead of air insufflation during endoscopy, an underwater investigation was performed in each patient after colonic water immersion. Efficacy of therapeutic endoscopy. Water-immersion endoscopy in each case allowed us to identify the location of the anastomosis and the source of active bleeding. It allowed us to safely place clips on the active vessels and stop the bleeding. Number of patients included, no comparison between conventional endoscopy and water-immersion endoscopy. Diagnostic as well as therapeutic water-immersion colonoscopy is safe in patients presenting with active lower GI bleeding in the early perioperative period after colorectal anastomosis.