Introduction: Post-sphincterotomy bleeding is a common adverse event after endoscopic retrograde cholangiopancreatography (ERCP). Factors like anticoagulation use and cirrhosis can increase risk of bleeding. The aim of this study is to demonstrate the incidence of post-sphincterotomy bleeding and to determine the efficacy of self-expanding metal stents (SEMS) in preventing post-sphincterotomy bleeding in patients with cirrhosis or on anticoagulation (AC).
Methods: A retrospective cohort study was performed using data derived from electronic medical records of patients who underwent ERCP with primary biliary sphincterotomy by advanced endoscopists since October 2022 at a tertiary care academic medical center. Relevant outcomes included bleeding risk post-sphincterotomy, severity of bleeding, effect of SEMS on bleeding. Patients were divided into three groups: patients with cirrhosis, those on AC, and those with neither.
Results: 317 patients met our inclusion criteria. 25 patients had a history of cirrhosis and 27 patients were actively on AC. Bleeding during ERCP was seen in 12.6% of cases (40 patients). 40% of these cases were treated conservatively/were self-limited, while others required interventions including epinephrine (20%), electrocautery coagulation (20%), clip placement (15%), and stent placement (15%). There is no statistical significance in incidence of bleeding between the 3 groups (X2 (df = 2, N = 317) = 1.557, p = 0.459). Of the 6 patients who had stents placed for bleeding during ERCP, none had post-ERCP bleeding, while post-ERCP bleeding occurred in 12 other patients who had no stents placed to prevent bleeding, although there was no statistical significance (p = 0.780). Furthermore, there is no statistical significance in post-ERCP bleeding when comparing any combination of the three groups (p = 1 between patients with cirrhosis and those with no risk factors, p = 0.306 between patients on AC and those with no risk factors, and p = 0.491 between those with cirrhosis and those on AC).
Discussion: There is no statistical significance in incidence of bleeding during ERCP or post-ERCP between patients with cirrhosis, those on AC (with appropriate washout period), and those with neither risk factors. Furthermore, SEMS seems to be effective in preventing further post-ERCP bleeding in those patients who had bleeding immediately after sphincterotomy, but more data is needed to determine if SEMS placement is more effective compared to other methods in preventing post-ERCP bleeding.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Linfeng Lu indicated no relevant financial relationships.
Kei Takigawa indicated no relevant financial relationships.
