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Post-biliary sphincterotomy bleeding despite covered metallic stent deployment.

Gianfranco Donatelli¹, Fabrizio Cereatti², Jean-Loup Dumont¹

¹Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.

SAGE Open Medical Case Reports

|August 5, 2016

Summary

Self-expandable metal stents (SEMS) can manage post-sphincterotomy bleeding. A case shows SEMS deployment did not prevent bleeding, requiring repeat endoscopic intervention for control.

Keywords:

Bleeding covered self-expandable metal stent endoscopic sphincterotomy self-expandable metal stent

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Area of Science:

Gastroenterology
Endoscopy
Biliary Interventions

Background:

Post-sphincterotomy bleeding is a known complication of endoscopic retrograde cholangiopancreatography (ERCP).
Various endoscopic hemostatic techniques exist, with self-expandable metal stents (SEMS) emerging as a rescue therapy.
The efficacy of SEMS in managing active post-sphincterotomy bleeding, particularly in the presence of an indwelling biliary stent, requires further investigation.

Observation:

A massive post-sphincterotomy bleeding occurred in a patient with a pre-existing, correctly positioned self-expandable metal stent in the biliary tree.
Despite the presence of the SEMS, the bleeding persisted and necessitated a repeat endoscopic session for successful hemostasis.

Findings:

Self-expandable metal stents may play a role in managing post-endoscopic sphincterotomy bleeding.
The current generation of SEMS may not be specifically designed to address this complication effectively.
A case demonstrated that even with a properly placed SEMS, additional endoscopic intervention might be required.

Implications:

Further research into specifically designed SEMS for post-sphincterotomy bleeding is warranted.
Biliary endoscopists may benefit from larger, purpose-built SEMS for managing this complication.
The findings highlight the need for tailored endoscopic solutions for managing bleeding after sphincterotomy.