Clinical analysis of delayed papillary hemorrhage after endoscopic retrograde cholangiopancreatography

Abstract

Objective To evaluate the clinical feature and potential reasons of delayed papillary bleeding after endoscopic retrograde cholangiopancreatography (ERCP), and search for effective hemostasis and strategies. Methods A total of 76 patients with post-ERCP bleeding underwent endoscopic treatment in the Eastern Hepatobiliary Hospital from August 2000 to August 2016. Clinical data, haemostatic methods, and treatment outcomes of patients were retrospectively analyzed. Results Delayed papillary hemorrhage mostly occurred within 48 hours after ERCP (67.2%, 45/67), with main manifestations of hematemesis, bloody stool, and bile. The lowest incidence of delayed bleeding was detected after endoscopic papillary balloon dilation (EPBD, 0.1%), which was followed by papillary precut (0.6%) and endoscopic sphincterotomy (EST, 0.9%). And EST+ EPBD had the highest incidence of delayed post-ERCP papillary hemorrhage (2.4%). The most bleeding site was the left side of the incision (67.1%, 51/76). Emergent endoscopic interventions were applied in all patients with success of hemostasis in 71 out of 76 (93.4%), and injection with diluted epinephrine, electric coagulation, hemoclipping, and metal stenting were used sequentially for hemostasis. Among the 71 successful cases of hemostasis, 66 patients were performed endoscopic hemostasis for once, 4 patients took twice, and 1 case took thrice. Endoscopic hemoclipping was the most commonly used method with successful rate of 76.9% (50/65) for hemostasis. Conclusion Precut papillotomy is safe and effective, and its complication occurrence rate is similar to that of EST. Hemorrhage should be prevented and timely dealt with in small/median EST and/or EPBD. Once hemorrhage is suspected clinically, endoscopic inventions should be applied timely, and hemoclipping is a safe and effective method. Key words: Cholangiopancreatography, endoscopic retrograde; Sphincterotomy, endoscopic; Endoscopic papillary balloon dilation; Delayed bleeding; Hemostasis