Surgeons Prepare for GI Bleeding When Endoscopy Isn’t Enough

Endoscopy and angiography have transformed the management of gastrointestinal (GI) bleeding, meaning surgeons are called on less often to intervene. But when those approaches fail, surgeons still need to know what to do.

Today’s Panel Session, “Surgical Management of Severe Gastrointestinal Bleeding” (PS202), from 8:00 to 9:30 am, will offer practical guidance for managing these uncommon but potentially high-stakes situations.

“The vast majority of gastrointestinal bleeds are managed endoscopically now, with angiography as a backup. So, we're not called to manage these patients surgically very often, and so when we are, it'd be nice to have a good approach on how to take care of these patients,” said co-moderator Carlos V. R. Brown, MD, FACS, chief of the Division of Acute Care Surgery at The University of Texas at Austin.

Five academic surgeons from around the country will provide tips and strategies for treating gastroduodenal, small bowel, colonic, anorectal, and occult GI bleeding.

The result will be “an efficient 90 minutes of learning,” said co-moderator Eric Ley, MD, FACS, chief of critical care at the R. Adams Cowley Shock Trauma Center in Baltimore, Maryland.

Both Drs. Brown and Ley emphasized that surgeons across specialties could benefit from attending.

“Anyone who's on a call schedule will be faced with this at some point. I don't think the specialty really matters,” Dr. Brown said.

“I think that even a busy minimally invasive surgeon's going to be faced with a bleeding hemorrhoid and is going to need to know how to manage that,” Dr. Ley added.

The session also will provide a refresher for experienced surgeons while reinforcing essential knowledge for residents and early career surgeons.

 “The experienced surgeon out in practice is going to benefit from the oversight from experts in the field presenting the latest management,” Dr. Ley said. “They probably learned a lot of it in training, but it's a refresher. I would also say that the residents and new grads are also going to benefit from this comprehensive refresher course of what they learned during their training.”

Advances in endoscopy and interventional radiology have made many traditional surgical approaches to GI bleeding less common, but the moderators emphasized that surgeons still need those skills when other options fail.

“In the end, the surgeon's got to be the goalie, and when everything else fails, there has to be a way to make the big save,” Dr. Brown said.

The session also builds on a long-standing collaboration between the two moderators, who trained together at what is now Los Angeles General Medical Center in California.

 “When I was his resident, he was the fellow, and we had some big saves with GI bleeds,” Dr. Ley said. “So, I'm very much looking forward to this session.”