S1120 Pre-Procedure Desmopressin and Bleeding Risk After Endoscopic Retrograde Cholangiopancreatography and Endoscopic Biliary Sphincterotomy

Abstract

Introduction: Intravenous Desmopressin (DDAVP) is sometimes given to uremic patients before endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy to reduce the risk post-sphincterotomy bleeding. However, this is based on extrapolation from previous studies that evaluated the use of desmopressin prior to surgery or renal biopsy to decrease the risk of bleeding and transfusion requirements. The aim of this study was to identify the impact of desmopressin on post-sphincterotomy bleeding rates after ERCP. Methods: We performed a single-center retrospective study of patients who underwent an ERCP with sphincterotomy at our institution between January 2011 and January 2021. Primary outcomes were the rate of post sphincterotomy bleeding (PSB). Descriptive statistics and univariable analysis were performed. Results: 2500 patients underwent ERCP with sphincterotomy during the study period, 99 (4.0%) of which received DDAVP. Post-sphincterotomy bleeding occurred in 31 patients (1.24%). Patients who experienced PSB had higher BUN (p< .001), were more likely to be on hemodialysis (p=.04) and were more likely to receive DDAVP (p< .001). (Table) Conclusion: Post-sphincterotomy bleeding was more likely to occur in patients who received desmopressin. This suggests that desmopressin does not reduce PSB and therefore should not be used for this purpose. Uremia and renal failure are associated with PSB, but desmopressin does not reduce this risk. Table 1. - Patient characteristics comparing patients who had post-sphincterotomy bleed and those who did not Variables PSBN=31 No PSBN=2469 P-value Age 58.6±24.0 54.4±20.9 .17 Gender Female 16 (51.6) 1,405 (56.9) .55 Pre-op Labs BUN 22.0±17.4 13.2±10.3 < .001 Cr 1.47±1.4 0.90±0.71 .037 INR 1.2±0.3 1.1±0.2 .26 Platelets 213.0±118.5 240.0±108.8 .12 Anti-platelets Aspirin 8 (25.8) 541 (21.9) .60 Clopidogrel 1 (3.2) 32 (1.3) .35 DAPT 1 (3.2) 17 (.69) .09 Anticoagulation Any 1 (3.2) 109 (4.4) .75 Enoxaparin 0 (0) 25 (1.0) .50 Warfarin 1 (3.2) 35 (1.4) .40 Rivaroxaban 0 (0) 29 (1.2) .54 Apixaban 0 (0) 39 (1.6) .48 Edoxaban 0 (0) 1 (.04) Dabigatran 0 (0) 5 (0.2) .80 DVT Prophylaxis Subcutaneous Heparin 4 (12.9) 291 (11.8) .85 Enoxaparin 0 (0) 50 (2.0) .42 ESRD 3 (9.7) 80 (3.2) .04 DDAVP 6 (19.4) 93 (3.8) < .001 Values are reported as n (%) or mean±SD.