Bleeding after endoscopic sphincterotomy: Single center retrospective study

Background and Aims: Endoscopic retrograde cholangiopancreatography is an effective diagnostic and therapeutic method; however, its invasive nature can lead to serious complications, including bleeding. The primary aim of this retrospective study, which was performed in a tertiary reference center, was to demonstrate the frequency, severity, and types of post-endoscopic sphincterotomy bleeding, identify the risk factors of post-endoscopic sphincterotomy bleeding, and determine the appropriate treatments for these patients. Material and Methods: Medical information on patients treated with endoscopic retrograde cholangiopancreatography between February 2008 and April 2013 was examined retrospectively. In this period, a total of 12,893 patients were detected; 6552 of them had no previous endoscopic retrograde cholangiopancreatography history. Patients with bleeding after endoscopic sphincterotomy were included in the study. Results: The frequency of bleeding after endoscopic sphincterotomy was 1.23% (81 patients). The mean patient age was 64.9 (18–89) years, 46 patients were women (56.8%), and 35 patients were men (43.2%). Immediate bleeding was observed in 50 (61.7%) patients, and delayed bleeding was observed in 31 (38.3%) patients. Most bleeding episodes were mild (53 patients, 65.4%), moderate bleeding was seen in 21 patients (25.9%), and severe bleeding was seen in 7 (8.6%) patients. Epinephrine injection alone was the most frequent treatment method (41 patients, 50.6%), followed by epinephrine injection plus heater probe (25 patients, 30.8%), heater probe alone (7 patients, 8.6%), epinephrine injection plus balloon tamponade (3 patients, 3.7%), balloon tamponade alone (2 patients, 2.4%), self-expandable full covered metal stent (2 patients, 2.4%), and endoclips alone (1 patient, 1.2%). These patients did not require surgery, and mortality was not observed. Conclusion: To date, the frequency of post- endoscopic sphincterotomy bleeding is lower than reported by older studies; nonetheless, bleeding is an important complication of endoscopic retrograde cholangiopancreatography. We found a 1.23% frequency of post-endoscopic sphincterotomy bleeding, in agreement with previous literature. Our study also demonstrates the importance of early diagnosis and prompt treatment of this complication