Endoscopic biliary sphincterotomy in patients under antithromboembolic therapy

Area of Science:

• Gastroenterology
• Endoscopy
• Hepatobiliary Surgery

Background:

• Endoscopic sphincterotomy (EST) is associated with risks, including bleeding, particularly in patients on antithromboembolic therapy.
• Current guidelines recommend caution for high-risk procedures in these patients, but supporting data is limited.
• EST is often an emergency procedure, necessitating evaluation of bleeding risks in patients on antithromboembolic agents.

Purpose of the Study:

• To evaluate the incidence of procedural bleeding in patients undergoing EST while on antithromboembolic therapy.
• To assess the impact of antithromboembolic agents (aspirin, clopidogrel, heparin) on bleeding rates after EST.
• To identify factors associated with increased bleeding risk following EST.

Main Methods:

• Retrospective study of 1798 consecutive patients undergoing EST between March 2005 and August 2015.
• Concomitant antithromboembolic therapy was recorded.
• Procedural bleeding events post-sphincterotomy were documented and analyzed.

Main Results:

• The bleeding rate was 3.6% in patients without antithromboembolic therapy and 6.3% in those with therapy.
• Bleeding rates for aspirin, clopidogrel, and heparin users were 5.7%, 2.9%, and 5.7%, respectively.
• No statistically significant increase in bleeding was observed compared to controls, but lower physical health scores and precut papilla procedures were associated with significantly increased bleeding (p < 0.01).

Conclusions:

• Bleeding following EST is not significantly increased in patients taking aspirin, clopidogrel, or heparin.
• Bleeding rarely necessitates packed red blood cell transfusion or leads to increased mortality.
• Patients with compromised health status or those requiring a precut papilla procedure exhibit a higher risk of bleeding after EST.