Gastro Hep Adv. 2025 Oct 12;5(4):100835. doi: 10.1016/j.gastha.2025.100835. eCollection 2026.
ABSTRACT
BACKGROUND AND AIMS: Crohn’s disease (CD) patients may experience anastomotic bleeding after lower gastrointestinal surgery, but its endoscopic management remains underexplored. We aimed to analyze the risk factors for anastomotic bleeding and the efficacy of endoscopic treatment.
METHODS: We retrospectively analyzed clinical characteristics, endoscopic treatments, and outcomes of CD patients with postoperative anastomotic bleeding from January 2021 to May 2025 at multiple centers. Anastomotic bleeding was defined as (i) direct bleeding (melena/hematochezia) or (ii) hemoglobin decrease ≥2 g/dL. Patients were followed up for 1 year, with rebleeding requiring endoscopic reintervention.
RESULTS: We included a total of 21 patients with 100% of patients having onsite bleeding controlled with initial endoscopic treatment and 9 patients (42.9%) having rebleeding. There was no statistical difference between the rebleeding group and nonrebleeding group in terms of age, gender, comorbidity, anticoagulation or antiplatelet therapy, clotting disorder, hemoglobin before or after procedure, bleeding type, the Rutgeert’s score, and endoscopic treatment. However, a greater number of patients in the rebleeding group required blood transfusion (88.9% vs 33.3%, P value = .011), and a greater volume of blood transfusion 2.0 (2.0-3.5 units) vs 0.0 (0.0-1.8 units) than those in nonrebleeding group (P value = .013). None of the 21 patients had no endoscopy-associated complications.
CONCLUSION: Endoscopic therapy appears to be safe and effective for the majority of CD patients with anastomotic bleeding following bowel surgery. The requirement for blood transfusion at the inception, in conjunction with a high volume of blood transfusion appear to be high risk factors for rebleeding.
PMID:41810383 | PMC:PMC12969671 | DOI:10.1016/j.gastha.2025.100835
