Characteristics of delayed hemorrhage after endoscopic sphincterotomy

Hemorrhage is one of the most common complications associated with endoscopic sphincterotomy (EST). Although most hemorrhage occurs immediately after EST, delayed hemorrhage may occur, even several days after EST. We analyzed the incidence, clinical features, treatment and risk factors for delayed hemorrhage following EST.

The medical records of 1549 patients who underwent EST between January 2000 and December 2006 were reviewed retrospectively. Delayed hemorrhage was defined as hemorrhage that developed 24 h after EST.

Of the 1549 patients who underwent EST, early hemorrhage during the procedure occurred in 45 patients (2.9%) and delayed hemorrhage occurred in 20 patients (1.3%). The time interval between EST and delayed hemorrhage was 4.8 +/- 3.2 days (range, 1-15 days). Major hemorrhage developed in 80% of the patients with delayed hemorrhage. The mean decrease of hemoglobin was 3.5 +/- 1.9 g/dL. The presenting symptoms of delayed hemorrhage included melena (80%), postural hypotension (80%), resting tachycardia (45%) and acute cholangitis (20%). All bleeding was successfully controlled by endoscopic treatment. Based on multivariate analysis, chronic kidney disease (CKD), hypertension and ischemic heart disease (IHD) were significant risk factors for delayed hemorrhage.

Complete control of intra-procedural bleeding is an important step in the prevention of late post-EST hemorrhage. Careful observation for delayed hemorrhage after EST, especially in patients with CKD, hypertension and IHD, is recommended.