Post-Pancreatectomy Hemorrhage: Is Endoscopy Really Useful?
Post-pancreatectomy hemorrhage is a frequent adverse event with high morbidity and mortality. Most bleeding originated from gastro-duodenal artery stump. Multidisciplinary approach is involved in the management of this complication including redo surgery, interventional radiology and operative endoscopy.
Assuming that, abdominal computerized tomography scan is mandatory prior to every kind of treatment to assess
the integrity of the anastomoses, eventual active blushing and/or emoperitoneum. Mean sensitivity was assessed at 56-67%.
If it is true that endoscopy can be both diagnostic and therapeutic in more and more surgical complications, it should be avoided to manage bleeding in this setting if any sign of anastomotic dehiscence is present.
In this case, the most common cause of bleeding is extraluminal bleeding and endoscopy can only worsen the situation by CO2 /air inflation, washing and pushing the instruments. Moreover, the entity of bleeding does not lead to add any even diagnostic information on the source.
Considering the literature, hemorrhage source was not found in 31% patients during endoscopy. Operative endoscopy can play an efficient role in case of bleeding from the gastro-jejunal anastomosis and can diagnose if the bleeding comes from the gastro-jejunal anastomosis or from the bilio-pancreatic jejunal loop.
However, literature data reported a 48% success rate and 24% mortality. On the other hand, endoscopy seems to be more effective in delayed bleeding with a source control success in 85.7% of cases.
Pancreas Open J. 2023; 6(1): e1-e2. doi: 10.17140/POJ-6-e014