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Endoscopic sphincterotomy in adult hemophiliac patients with choledocholithiasis
Panagiotis Katsinelos1, Ioannis Pilpilidis, George Paroutoglou
1Second Department of Internal Medicine, Aristotelion University, Ippokration Hospital, Thessaloniki, Greece.
Insights
Adults with hemophilia can safely undergo endoscopic sphincterotomy for bile duct stones with careful factor replacement and monitoring, avoiding bleeding complications.
Area of Science:
- Gastroenterology
- Hematology
- Interventional Endoscopy
Background:
- Choledocholithiasis is a common condition requiring intervention.
- Hemophilia poses a significant bleeding risk during invasive procedures.
- Endoscopic sphincterotomy is a standard treatment for choledocholithiasis.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic sphincterotomy in hemophilia patients.
- To determine the risk of bleeding complications in this patient population.
- To establish optimal management strategies for hemophilia patients undergoing ERCP.
Main Methods:
- Retrospective analysis of 9 hemophilia patients (7 A, 2 B) undergoing ERCP for choledocholithiasis from 1983-2002.
- Pre- and post-procedure monitoring of clotting factor levels.
- Factor replacement therapy to achieve 100% activity before and for 24 hours post-procedure.
- Comparison of continuous infusion versus intermittent factor replacement.
Main Results:
- No bleeding complications were observed in any of the 9 patients.
- Both continuous and intermittent factor replacement strategies were effective.
- Patients receiving continuous infusions maintained higher factor levels post-procedure.
Conclusions:
- Endoscopic sphincterotomy is a safe procedure for hemophilia patients with appropriate management.
- Meticulous hemostasis, vigilant monitoring, and timely factor replacement are crucial for preventing bleeding.
- This approach allows hemophiliacs to benefit from ERCP for choledocholithiasis.
Background:
The aim of this study was to investigate the risk of bleeding in adult hemophiliac patients undergoing endoscopic sphincterotomy for choledocholithiasis.
Methods:
From 1983 to 2002, 7 patients with hemophilia A and two with hemophilia B were referred for endoscopic sphincterotomy and extraction of bile duct stones. The degree of hemophilia was mild in 4 patients, moderate in 3, and severe in two. Pre-admission levels of blood clotting factors ranged from less than 1% to 18%. Levels of the deficient factors were monitored carefully before and after sphincterotomy, and the relevant factor was replaced to achieve 100% activity before and for 24 hours after endoscopic sphincterotomy.
Observations:
Seven patients had factor replacement every 8 hours, and two received continuous infusions. No patient developed bleeding after sphincterotomy. At discharge, 48 hours after the procedure, patients who had received continuous infusions had a factor level of greater than 90%; those who had received intermittent replacement had levels of greater than 50%. After discharge, the patients were treated with regular infusion of the deficient factor for 15 days.
Conclusions:
With adequate preoperative and post-procedure monitoring of clotting factors, meticulous attention to hemostasis during sphincterotomy, careful post-procedure monitoring, and timely replacement therapy, patients with hemophilia can undergo endoscopic sphincterotomy without bleeding complications.
