Treatment for postendoscopic sphincterotomy bleeding with fully covered self-expanding metal stent: A feasible and safe method

摘要

Endoscopic sphincterotomy (ES) is necessary and even mandatory for the management of a variety of biliary diseases, such as common bile duct stones, during the procedures of endoscopic retrograde cholangiopancreatography (ERCP). However, inevitably, bleeding is one of the most frequent and serious adverse events associated with ES. Risk factors for postsphincterotomy (post-ES) bleeding includes coagulopathy, recent anticoagulation medication, cholangitis, cirrhosis, per-iampullary diverticulum, stone impaction, ampullary tumor, and extension of previous sphincterotomy.1"3 Moreover, the estimated rate of post-ES bleeding is about 0.3% to 2%2'4'5 depending on the definition of significant bleeding. In addition to endoscopic evidence, bleeding is believed to be significant only if certain signs appeared simultaneously, including melena or hematemesis, with a reduction of hemoglobin concentration >2 g/dL, or the need of blood transfusion. Besides, there should be no other identifiable cause of bleeding except ES in the same procedure. Moreover, it was estimated that half of the bleeding happened immediately after ES (procedural bleeding); a delay of 24 hours up to several days (delayed bleeding) was noted in rest of the patients.