Endoscopic Management of Early Upper Gastrointestinal Bleeding After Minimally Invasive Ivor-Lewis Esophagectomy

Abstract

Minimally invasive esophagectomy is now accepted as a regular treatment modality for esophageal cancer. Upper gastrointestinal (GI) bleeding is a common postoperative adverse event of esophagectomy. However, there are very few reports in the literature on endoscopic management of early upper GI bleeding after an esophagectomy. Here, we report the successful management of such an early case of GI bleeding after thoracolaparoscopic esophagectomy by the use of endoscopic intrathoracic anastomosis.

Endoscopic Management for Post-Surgical Complications after Resection of Esophageal Cancer

“…The use of Hemoclips offers an application via the working channel with a permanent view to the bleeding source. Hemoclips are suitable for anastomotic bleeding and do not injure the surrounding tissue [ 16 , 17 ].…”

A case report of endovascular management of delayed upper gastrointestinal bleeding after open esophagectomy for a benign esophageal stricture

“…The most common complications are cardiac, respiratory and gastric tube ischaemia or anastomotic leak [7] . However, delayed upper GI bleeding has only rarely been reported [2] , [3] , [4] . Our patient's case of delayed bleeding after an open esophagectomy for a benign stricture is likely to be even more uncommon.…”

“…There is some reluctance to use clips in the early post-operative period due to the risk of disrupting the anastomosis. However, there is at least one report of successful endoscopic management of a post-esophagectomy upper GI bleed with clips which avoided the need for a second surgery [2] .…”

“…Upper gastrointestinal (GI) bleeding is a recognised complication of esophagectomy and affects 0.3% of patients [1] . Delayed bleeding into the gastric conduit has been rarely reported in the literature [2] , [3] , [4] . Bleeding after an open esophagectomy with no preoperative chemotherapy or radiotherapy is even more uncommon.…”