Treatment of bleeding after bariatric surgery

Upper gastrointestinal hemorrhage (UGH) is a potential postoperative complication after bariatric surgery. The etiology of postoperative UGH after open or laparoscopic gastric bypass is most likely related to problems at the staple line. There are four potential sites of staple-line hemorrhage: the gastrojejunostomy, the gastric pouch, the jejunojejunostomy, and the excluded stomach. The site of bleeding can sometimes be predicted based on the clinical presentation. Early bleeding usually occurs at the gastrojejunostomy. Late UGH is commonly caused by a marginal ulcer. Upper endoscopy is safe and effective in controlling hemorrhage with standard endoscopic techniques, even in the early postoperative period and may obviate the need for surgery. Hemostatic methods include epinephrine, electrocautery, and endoclips. Endoscopy has variable success in the management of bleeding at the jejunojejunostomy and excluded stomach because of the long length of the Roux limb. Hybrid procedures may be needed in these cases.