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Endoscopic papillary balloon dilation decreases the risk of bleeding in cirrhotic patients compared with endoscopic

Tsung-Hsing Hung1,2, Chih-Wei Tseng1,2, Yen-Chun Chen1,2

  • 1Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi.

Medicine
|July 27, 2019
PubMed

Insights

Endoscopic papillary balloon dilation (EPBD) is safer than endoscopic biliary sphincterotomy (EST) for cirrhotic patients, reducing bleeding risk. EPBD is preferred for those with kidney issues or on blood thinners.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endoscopic Procedures

Background:

  • Cirrhotic patients face increased risks during endoscopic retrograde cholangiopancreatography (ERCP).
  • Optimal methods to minimize bleeding after ERCP in cirrhosis remain unclear.
  • Endoscopic papillary balloon dilation (EPBD) may offer a lower bleeding risk compared to endoscopic biliary sphincterotomy (EST).

Purpose of the Study:

  • To compare the post-ERCP bleeding risks between EST and EPBD in cirrhotic patients.
  • To identify clinical factors associated with bleeding and 30-day mortality after these procedures.
  • To establish recommendations for safer ERCP in patients with cirrhosis.

Main Methods:

  • Retrospective analysis of Taiwan's National Health Insurance Database (2010-2013).
  • Inclusion of 3201 cirrhotic patients undergoing either EST (n=2620) or EPBD (n=581).
  • Comparison of bleeding incidence and identification of mortality risk factors.

Main Results:

  • EPBD showed a lower bleeding incidence (1.9%) compared to EST (3.5%).
  • Independent bleeding predictors included EST, renal impairment, and antiplatelet/anticoagulant use.
  • Factors associated with higher 30-day mortality included older age, renal impairment, hepatic encephalopathy, esophageal varices, ascites, and malignancies.

Conclusions:

  • EPBD is the preferred endoscopic intervention for reducing post-ERCP hemorrhage in cirrhotic patients.
  • Particular benefit of EPBD observed in patients with renal impairment or on antithrombotic therapy.
  • Risk stratification for mortality is crucial in cirrhotic patients undergoing ERCP.

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