Endoscopic sphincterotomy in adult hemophiliac patients with choledocholithiasis.
BACKGROUND
The aim of this study was to investigate the risk of bleeding in adult hemophiliac patients undergoing endoscopic sphincterotomy for choledocholithiasis.


METHODS
From 1983 to 2002, 7 patients with hemophilia A and two with hemophilia B were referred for endoscopic sphincterotomy and extraction of bile duct stones. The degree of hemophilia was mild in 4 patients, moderate in 3, and severe in two. Pre-admission levels of blood clotting factors ranged from less than 1% to 18%. Levels of the deficient factors were monitored carefully before and after sphincterotomy, and the relevant factor was replaced to achieve 100% activity before and for 24 hours after endoscopic sphincterotomy.


METHODS
Seven patients had factor replacement every 8 hours, and two received continuous infusions. No patient developed bleeding after sphincterotomy. At discharge, 48 hours after the procedure, patients who had received continuous infusions had a factor level of greater than 90%; those who had received intermittent replacement had levels of greater than 50%. After discharge, the patients were treated with regular infusion of the deficient factor for 15 days.


CONCLUSIONS
With adequate preoperative and post-procedure monitoring of clotting factors, meticulous attention to hemostasis during sphincterotomy, careful post-procedure monitoring, and timely replacement therapy, patients with hemophilia can undergo endoscopic sphincterotomy without bleeding complications.
Second Department of Internal Medicine, Aristotelion University, Ippokration Hospital, Thessaloniki, Greece.
Panagiotis
P
Katsinelos
Ioannis
I
Pilpilidis
George
G
Paroutoglou
Panagiotis
P
Tsolkas
Ioannis
I
Galanis
Olga
O
Giouleme
Kostas
K
Soufleris
Stergios
S
Vradelis
Nikos
N
Eugenidis
D000328:Adult; D000368:Aged; D042883:Choledocholithiasis / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome