title: Bleeding after sphincterotomy in liver transplanted patients with biliary complications.
abstract: OBJECTIVE
  To investigate the rate of immediate persistent bleeding requiring haemostasis and of delayed bleeding after endoscopic sphincterotomy in liver transplanted patients.
  
  
  METHODS
  Clinical records of patients who underwent endoscopic sphincterotomy at our Center between January 2003 and December 2009 were reviewed. Platelets count, international normalized ratio, aminosalicylic acid use, presence of cholangitis and use of precut were evaluated as risk factors for bleeding. Crude and adjusted risk ratios (RR) with 95% confidence interval were calculated, using Poisson model.
  
  
  RESULTS
  Forty-nine liver transplanted patients and 202 controls were studied. Rate of delayed bleeding, but not need of immediate haemostasis, was increased in liver transplanted patients, RRs of 11.0 (3.0-40.0) and 1.5 (0.7-3.4) respectively. The RR of delayed bleeding remained unchanged once adjusted for the other evaluated variables.
  
  
  CONCLUSIONS
  In liver transplanted patients, the risk of bleeding after endoscopic sphincterotomy is markedly increased. Reasons for this increase still need to be elucidated.
authors.affiliation: Gastrointestinal Unit 2, Università degli Studi di Milano and Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tenca
authors.forename: Delia
authors.initials: D
authors.lastname: Pugliese
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.forename: Paolo
authors.initials: P
authors.lastname: Cantù
authors.forename: Giorgio
authors.initials: G
authors.lastname: Rossi
authors.forename: Maria
authors.initials: M
authors.lastname: Francesca Donato
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: Roberto
authors.initials: R
authors.lastname: Penagini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy; D011184:Postoperative Period; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D055815:Young Adult