title: Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding.
abstract: OBJECTIVE
  To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy (ES) bleeding.
  
  
  METHODS
  Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, co-morbidities, endoscopic diagnosis, presence of peri-ampullary diverticulum, occurrence of immediate post-ES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy.
  
  
  RESULTS
  A total of 35 patients (21.7%) had re-bleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/dL, initial bleeding severity, and bleeding diathesis were significant predictors of re-bleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/dL and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single (n = 23) or multiple (range, 2-7; n = 6) sessions in 29 of the 35 patients (82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding.
  
  
  CONCLUSIONS
  Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/dL are predictors of re-bleeding.
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Mu-Hsien
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Yung-Kuan
authors.initials: YK
authors.lastname: Tsou
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Cheng-Hui
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Ching-Song
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Liu
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Kai-Feng
authors.initials: KF
authors.lastname: Sung
authors.affiliation: Mu-Hsien Lee, Yung-Kuan Tsou, Cheng-Hui Lin, Ching-Song Lee, Nai-Jen Liu, Kai-Feng Sung, Hao-Tsai Cheng, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
authors.forename: Hao-Tsai
authors.initials: HT
authors.lastname: Cheng
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D016558:Hemostasis, Endoscopic / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000401:mortality; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin
keywords: Delayed bleeding; Endoscopic hemostasis; Endoscopic sphincterotomy; Predictors; Re-bleeding