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Safety of endoscopic sphincterotomy in patients under dual antiplatelet therapy

Ahmed Abdel Samie A, Rui Sun, Ulrich Vöhringer

    Hepato-Gastroenterology
    |November 29, 2012
    PubMed

    Insights

    Endoscopic biliary sphincterotomy (ES) can be safely performed in patients undergoing dual antiplatelet therapy. This study found no bleeding events in patients on aspirin and clopidogrel who underwent this high-risk procedure.

    Area of Science:

    • Gastroenterology
    • Cardiology
    • Endoscopic Procedures

    Background:

    • Dual antiplatelet therapy (DAPT) is standard after coronary stent placement (bare metal stents: ≥1 month; drug-eluting stents: ≥1 year).
    • Guidelines recommend delaying elective surgery until DAPT cessation due to bleeding risks.
    • Limited data exist on bleeding risks for DAPT patients undergoing high-risk endoscopic procedures like biliary sphincterotomy.

    Purpose of the Study:

    • To evaluate the safety of performing endoscopic sphincterotomy (ES) in patients on dual antiplatelet therapy.
    • To assess the bleeding risk associated with ES in patients receiving combined aspirin and clopidogrel therapy.

    Main Methods:

    • Retrospective analysis of medical records.
    • Inclusion of patients who underwent endoscopic retrograde cholangiography with endoscopic sphincterotomy (ES) while on DAPT.
    • Study period: January 2009 to December 2011.

    Main Results:

    • Eight consecutive patients on DAPT underwent ES.
    • No instances of bleeding were observed in these patients post-procedure.
    • ES was performed safely without complications related to antiplatelet therapy.

    Conclusions:

    • Endoscopic sphincterotomy (ES) appears to be a safe procedure for patients maintained on dual antiplatelet therapy.
    • The findings suggest that DAPT does not necessarily preclude the performance of ES in urgent or necessary cases.
    Abstract

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