Does withholding aspirin for one week reduce the risk of post-sphincterotomy bleeding?

Complications of endoscopic sphincterotomy are closely related to the endoscopic technique. To date, there have been no studies to indicate that aspirin increases the risk of bleeding after endoscopic sphincterotomy.

To compare the incidence of post-sphincterotomy bleeding in patients with and without prior aspirin therapy.

Eight hundred and four patients were recruited into this retrospective study: 124 patients continued to take aspirin until the day of sphincterotomy (Group 1), 116 patients had their aspirin discontinued for 1 week before sphincterotomy (Group 2) and 564 patients had never taken aspirin (Group 3). The primary outcome analysed was the incidence of post-sphincterotomy bleeding.

Sixty-seven patients (8.3%) developed post-sphincterotomy bleeding. The incidences of post-sphincterotomy bleeding in Groups 1, 2 and 3 were 9.7%, 9.5% and 3.9%, respectively. Group 1 showed significantly increased post-sphincterotomy bleeding when compared with Group 3 (P=0.01), and the risk was also significantly increased when Group 2 was compared with Group 3 (P=0.01). However, there was no significant difference in post-sphincterotomy bleeding between Groups 1 and 2 (P=0.96).

Aspirin therapy increased the risk of post-sphincterotomy bleeding. Withholding aspirin for 1 week before endoscopic sphincterotomy did not seem to decrease the risk of post-sphincterotomy bleeding.