title: Factors affecting the success of endoscopic treatment of sphincterotomy bleeding.
abstract: OBJECTIVE
  Endoscopic methods are effective in the control of endoscopic sphincterotomy (ES) bleeding. Initial failure or recurrent bleeding may develop in some patients, which may require angiographic or surgical interventions. We aimed to determine the factors leading to failure of endoscopic treatment methods.
  
  
  METHODS
  Forty-six patients (1.37%) had endoscopic and/or clinically significant bleeding among a total of 3354 ESs (2998 primary, 356 re-ES) performed within 3 years. Forty-one patients (21 immediate, 20 late onset bleeding) underwent endoscopic treatment. Nineteen patients were treated initially by epinephrine injection and 22 with heat probe. The relation between demographic, laboratory parameters, presence of comorbidity, cholangitis, coagulopathy, and juxtapapillary diverticula, pre-cutting, type of ES, time and pattern of bleeding, treatment modality, the success and relapse of endoscopic treatment were evaluated.
  
  
  RESULTS
  The first method was successful in the treatment of bleeding in 18 patients with heat probe and epinephrine injection, each. Presence of cholangitis, coagulopathy and increased international normalized ratio (INR) levels were found to determine the success of first treatment method. Bleeding could be stopped in all of the patients either with initially preferred or combined methods. Five patients developed recurrent bleeding. Presence of cholangitis, coagulopathy, increased INR levels, low thrombocyte counts and performance of precutting were factors predicting recurrence. Both of the treatment methods were 100% effective in patients without coagulopathy and none of the patients developed recurrent bleeding.
  
  
  CONCLUSIONS
  Treatment of ES bleeding in patients with high risks such as coagulopathy require new effective methods. Patients with coagulopathy must be carefully followed for the development of recurrent bleeding.
authors.affiliation: Türkiye Yüksek İhtisas Education and Training Hospital, Department of Gastroenterology, Ankara, Turkey. drerkanparlak@gmail.com
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Selçuk
authors.initials: S
authors.lastname: Dişibeyaz
authors.forename: Aydın Şeref
authors.initials: AŞ
authors.lastname: Köksal
authors.forename: Bülent
authors.initials: B
authors.lastname: Odemiş
authors.forename: Nurgül
authors.initials: N
authors.lastname: Saşmaz
authors.forename: Burhan
authors.initials: B
authors.lastname: Şahin
mesh_terms: D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy*; D012074:Remission Induction; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D016896:Treatment Outcome