Endoscopic hemostasis in sphincterotomy-induced hemorrhage: its efficacy and safety.
OBJECTIVE
Hemorrhage is induced in approximately 0.5-12% of endoscopic biliary sphincterotomy (ES) procedures. We prospectively investigated the risk factors for ES-induced hemorrhage and evaluated the safety as well as the effectiveness of endoscopic hemostasis.


METHODS
The study included 1304 patients who underwent ES between July 1996 and June 1998. Epinephrine spray was used initially for hemostatic treatment. If bleeding persisted, an epinephrine injection was given consecutively. In patients with exposed vessels, epinephrine injection followed by alcohol injection was given.


RESULTS
ES-induced hemorrhage occurred in 136 (10.4%) patients. The type of sphincterotome used (needle-knife sphincterotome, P=0.025) and the cutting speed (the so-called "zipper" cut, P = 0.049) were revealed as significant variables with regard to the occurrence of bleeding. Mild, moderate, and severe bleeding were noted in 108 (79.4%), 22 (16.2%), and six (4.4%) patients, respectively. Once bleeding occurred, patients with an associated ampullary lesion (impacted stone or cancer) or with coagulopathy were more likely to bleed profusely. Initial hemostasis was achieved in all patients. However, rebleeding occurred in eight patients who were initially classified as having moderate or severe bleeding. Finally, ES-induced hemorrhage was successfully controlled in all patients after 1-3 treatment sessions (mean 1.1 sessions). The difference in the incidence of complications between the groups treated or not treated by endoscopic hemostasis was not statistically significant.


CONCLUSIONS
ES-induced hemorrhage occurred in 10% of the patients studied. The use of needle-knife sphincterotomy and the cutting speed were independent risk factors for the occurrence of bleeding. Once bleeding occurred, its severity was affected by an associated ampullary lesion (impacted stone or cancer) or coagulopathy. Endoscopic hemostasis with epinephrine and/or alcohol was effective and safe in ES-induced hemorrhage.
Kim
H J
HJ
Dept. of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kim
M H
MH
Kim
D I
DI
Lee
H J
HJ
Myung
S J
SJ
Yoo
K S
KS
Park
E T
ET
Lim
B C
BC
Seo
D W
DW
Lee
S K
SK
Min
Y I
YI
D001660:Biliary Tract Diseases / Q000601:surgery; D016145:Endoscopy, Digestive System; D004837:Epinephrine / Q000008:administration & dosage; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D012449:Safety; D012997:Solvents / Q000008:administration & dosage; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D012997:Solvents; D014662:Vasoconstrictor Agents; D000431:Ethanol; D004837:Epinephrine