title: Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome.
abstract: OBJECTIVE
  To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality.
  
  
  METHODS
  From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected.
  
  
  RESULTS
  Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012).
  
  
  CONCLUSIONS
  Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival.
  
  
  CONCLUSIONS
  • Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding • The rate of rebleeding is acceptably low • Haemostatic disorders appear to significantly influence 30-day survival.
authors: Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium, geert.maleux@uzleuven.be.
authors: Geert
authors: G
authors: Maleux
authors: Jurgen
authors: J
authors: Bielen
authors: Annouschka
authors: A
authors: Laenen
authors: Sam
authors: S
authors: Heye
authors: Johan
authors: J
authors: Vaninbroukx
authors: Wim
authors: W
authors: Laleman
authors: Peter
authors: P
authors: Verhamme
authors: Alexander
authors: A
authors: Wilmer
authors: Werner
authors: W
authors: Van Steenbergen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome