Injection treatment of hemorrhage induced by endoscopic sphincterotomy.
OBJECTIVE
Hemorrhage is one of the most common severe complications after endoscopic sphincterotomy (ES) and the mortality after surgical treatment can be as high as 50%. We prospectively evaluated the effect of injection treatment in nine patients with appreciable hemorrhage after ES.


METHODS
Bleeding was detected immediately after ES in five patients and 48, 72, 120 and 216 hours after the procedure in the remaining four. Patients were treated with a combined injection of epinephrine and polidocanol (1-3 and 3-6 ml, respectively) into the bleeding site.


RESULTS
Treatment was effective in arresting hemorrhage in all cases. Two patients had abnormal clotting tests, which emphasizes the importance of identifying risk factors for hemorrhage before ES. No patient required operation and there were no late complications related to the injection during a mean follow-up period of six months.


CONCLUSIONS
Our results suggest that bleeding after sphincterotomy can be safely and effectively controlled by a combined epinephrine and polidocanol injection, thereby avoiding operation.
Vásconez
C
C
Gastroenterology Department, Hospital Clinic i Provincial, Barcelona, Spain.
Llach
J
J
Bordas
J M
JM
Ginès
A
A
Elizalde
J I
JI
Mondelo
F
F
Terés
J
J
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D012597:Sclerosing Solutions; D014662:Vasoconstrictor Agents; D004837:Epinephrine