title: Is there a safer electrosurgical current for endoscopic sphincterotomy in patients with liver cirrhosis?
abstract: BACKGROUND
  Endoscopic sphincterotomy has a higher risk of bleeding in patients with cirrhosis. Advanced Child stage and coagulopathy are well-known risk factors. We aimed to determine the role of electrosurgical currents in the development of endoscopic sphincterotomy bleeding in cirrhotic patients.
  
  
  METHODS
  The study was a retrospective observational study and included 19,642 patients who underwent endoscopic retrograde cholangiopancreatography between 2004 and 2013. The incidence of endoscopic sphincterotomy bleeding in cirrhotic patients who underwent sphincterotomy after 2009 with an electrosurgical generator applying alternating current in the pulse cut mode (Group 2) was compared with a historical control group who underwent endoscopic sphincterotomy between 2004 and 2009 via blended current (Group 1).
  
  
  RESULTS
  Group 1 included 15 patients (six women, nine men, mean age: 62.2 ± 12.9 years). Group 2 included 14 patients (six women, eight men, mean age: 63.6 ± 16.9 years). There was no statistically significant difference between the demographic and clinical characteristics of the two groups. Endoscopic sphincterotomy bleeding was observed in three patients in Group 1 (two endoscopic bleeding and one clinically significant bleeding) and none of the patients in Group 2 (p = 0.77). There were no cases of perforation or pancreatitis in both groups. One patient in Group 2 developed cholangitis.
  
  
  CONCLUSIONS
  Endoscopic sphincterotomy bleeding is less frequently observed in patients with cirrhosis who underwent sphincterotomy with alternating mixed current in the pulse cut mode compared with those with blended current.
authors.affiliation: Department of Gastroenterology, Sakarya University, Sakarya, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.affiliation: Department of Gastroenterology, Sakarya University, Sakarya, Turkey. koksalas@yahoo.com.|Kızılırmak mahallesi, 1443. Cadde, 40/13, Çukurambar, Ankara, Turkey. koksalas@yahoo.com.
authors.forename: Aydın Şeref
authors.initials: AŞ
authors.lastname: Köksal
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Erkin
authors.initials: E
authors.lastname: Öztaş
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Selçuk
authors.initials: S
authors.lastname: Dişibeyaz
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Ödemiş
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yüksel
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yıldız
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Nurgül
authors.initials: N
authors.lastname: Şaşmaz
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey.
authors.forename: Burhan
authors.initials: B
authors.lastname: Şahin
mesh_terms: D004307:Dose-Response Relationship, Radiation; D004598:Electrosurgery / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011829:Radiation Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
keywords: Cirrhosis; ERCP; Endoscopic therapy; Gastrointestinal hemorrhage; Sphincterotomy