Su1346 Prophalactic Hemoclip Application At ERCP to Prevent Post-ES Bleeding in Patients Receiving Anticoagulation or Antiplatelet Therapy

Abstract

The risk of immediate or delayed post-endoscopic sphincterotomy bleeding (PESB) is reported to range from 2.0-5.3%, but can be as high as 10% to 25% in the setting of high risk patients (pts) receiving anti-platelet agents or anti-coagulation therapy. These pts present a particular challenge when definitive ERCP sphincterotomy (ES) is indicated. Mechanical clipping of PESB has been reported but infrequently used due to the difficulty in placing the current generation of clips using ERCP endoscopes as well as the potential risk of inadvertent application of clips on the pancreatic orifice. However, hemoclip placement has been shown to be highly effective in mechanical closure of a wide variety of bleeding and potential bleeding lesions of the GI tract. We present our single center experience with prophylactic hemoclip placement to prevent PESB in the setting of antiplatelet/anticoagulation Rx.