Early GI bleeding after bariatric surgery

The approach to early postoperative GI hemorrhage, arbitrarily defined as bleeding occurring within 2 weeks after bariatric surgery, differs from that of bleeding in patients with native anatomy. Early GI bleeding is more often a complication associated with Roux-en-Y gastric bypass (RYGB) surgery than other bariatric procedures and typically involves the gastrojejunal anastomosis or gastric staple line. GI bleeding that occurs beyond the early postoperative period is more commonly due to marginal ulceration. Conservative management suffices in many cases, but endoscopy with therapeutic intent should be considered in patients in whom bleeding is severe or recurs. This chapter reviews early postoperative bleeding following RYGB and proposes a management algorithm.