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Refractory bleeding after endoscopic sphincterotomy: a new indication for recombinant factor VII therapy?
R Romero-Castro1, M Jiménez-Sáenz, F Pellicer-Bautista
1Department of Gastroenterology, Virgen Macarena University Hospital, Seville, Spain.
The American Journal of Gastroenterology
|September 28, 2004
Summary
Refractory bleeding after endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy can be life-threatening. Recombinant activated factor VII (rFVIIa) offers a safe and effective second-line treatment option for severe cases.
Area of Science:
- Gastroenterology
- Hematology
- Endoscopic Procedures
Background:
- Post-ERCP bleeding management typically involves endoscopic epinephrine injection.
- Severe or refractory bleeding poses significant risks, including fatality.
- Existing treatments may be insufficient for massive or difficult-to-manage bleeding.
Observation:
- A case of refractory post-endoscopic sphincterotomy (ES) bleeding without coagulopathy was reported.
- The patient experienced massive bleeding, obscuring endoscopic vision and complicating treatment.
- Standard endoscopic interventions were ineffective.
Findings:
- Successful treatment of refractory post-ES bleeding was achieved with a single injection of recombinant activated factor VII (rFVIIa).
- rFVIIa demonstrated safety and efficacy as a second-line therapy in this specific case.
- No pre-existing coagulopathy was present in the patient.
Implications:
- rFVIIa may be a valuable therapeutic option for refractory or massive post-ES bleeding.
- This approach could be considered a non-invasive, second-line intervention.
- Further research is warranted to confirm the safety and cost-effectiveness of rFVIIa in managing such complications.