eP652 - Flexible Endoscopic Assessment of Left Sided Colonic Anastomoses for Diagnosis and Treatment of Anastomotic Bleeding - 1 Year Data Analysis

Purpose/Background: About 60% of patients undergoing colon surgery for benign and malignant diagnoses have surgery including the descending and/or sigmoid colon requiring the creation of a left sided colonic anastomosis. These left sided anastomoses have a historical bleeding rate of 2-6%. After creation of an anastomosis, it is standard practice to examine the site intra-operatively with a sigmoidoscope to assess anastomotic integrity. Both rigid and flexible sigmoidoscopes facilitate identification of anastomotic leakage; however, recent literature suggests that the flexible sigmoidoscopy may afford better visualization and evaluation of the anastomotic site. To date there are no United States based clinical studies assessing the efficacy of intra-operative examination and endoscopic clipping of bleeding anastomoses, with either flexible or rigid techniques. The purpose of this study is to compare intra-operative discovered anastomotic bleeding by both rigid and flexible sigmoidoscopy and to evaluate the efficacy of immediate intervention for anastomotic bleeding. In addition, we looked at how intra-operative bleeding detection affected patients' post-operative outcomes. This study is currently ongoing, but we wanted to analyze our 1 year data.Methods/Interventions: This study is a prospective study evaluating all left sided colonic anastomoses that took place at a single institution between June 2022 to August 2023. The data was obtained and collected from the electronic medical records.Results/Outcomes: To date, this study has enrolled 121 patients with a cumulative rate of anastomotic bleeding of 4.96% (6 patients total; 4 identified intra-operatively and 2 identified post-operatively). In our study, 0% of bleeds were identified using rigid sigmoidoscope and 66.7% were identified using flexible sigmoidoscope. All 4 of the intra-operative anastomotic bleeds identified by flexible sigmoidoscope were treated with endoscopic clips with no further bleeding, no statistically significant increase in operative time and no need for post-operative intervention. The anastomotic bleeds that were detected post-operatively had, on average, higher rate of need for transfusion (50% versus 0%), longer hospital length of stay (15.5 versus 3.5 days), and lower post-operative hemoglobin (9.6 versus 12.6). The post-operative anastomotic bleeds had, on average, a higher rate of post-operative complications such as ileus (50% versus 0%), infection (50% versus 25%), and higher rate of discharge to a facility other than home (50% versus 0%). For the two patients who bled post-operatively, one required endoscopic intervention with an endoscopic clip and the other was complicated by an anastomotic leak that required percutaneous drainage. Neither patient required re-operation.Conclusion/

Discussion: Based on our 1 year data, it is clear that flexible sigmoidoscopy is better at detecting intra-operative anastomotic bleeding when compared to rigid sigmoidoscopy. It is important to note that the anastomotic bleeds that were detected intra-operatively were able to have an immediate intervention during the initial operation and, overall, had less post-operative morbidity when compared to the post-operative anastomotic bleeds. The post-operative anastomotic bleed rate was 1.6%. This preliminary data suggests a benefit to using flexible sigmoidoscopy to detect and treat intra-operative anastomotic bleeds when performing a left sided colonic anastomosis. As the sample size grows, more robust conclusions can be made in the future."Table 1

Rate of bleeding detected intraoperatively by rigid and flexible sigmoidoscopy. When comparing the rate of detection of intraoperative bleeding between rigid and flexible sigmoidoscopy, flexible sigmoidoscopy was better at detecting intraoperative bleeding (p value 0.014).
Table 2

Comparison of outcomes between the intraoperative anastomotic bleeds versus the postoperative anastomotic bleeds."