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Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Hepatology

Background:

  • Clinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding (CSPEB) is a recognized complication.
  • Current estimates of CSPEB risk and associated factors are limited.

Purpose of the Study:

  • To identify risk factors for CSPEB.
  • To determine the outcomes associated with CSPEB.
  • To evaluate the impact of antithrombotic medications on CSPEB risk.

Main Methods:

  • Prospective, multi-center analysis of ERCP data from 2018-2023.
  • Inclusion of 30-day follow-up for all patients.
  • Definition of CSPEB based on specific clinical criteria (hematemesis, melena, hematochezia) and consequences (hemoglobin drop, transfusion, endoscopy, prolonged admission).
  • Statistical analysis using Firth logistic regression to identify significant risk factors.

Main Results:

  • CSPEB occurred in 1.5% of 8,517 ERCPs, with a higher incidence (2.3%) after high-risk interventions.
  • Antithrombotic agents, including P2Y12 inhibitors, warfarin, dabigatran, rivaroxaban, and apixaban, were significantly associated with CSPEB following higher-risk procedures.
  • Intraprocedural bleeding during sphincterotomy was also a risk factor.
  • CSPEB was associated with increased need for endoscopy, transfusion, and a higher rate of concomitant cardiorespiratory events.

Conclusions:

  • The risk of CSPEB associated with antiplatelet therapy may be underestimated.
  • Suboptimal management of antithrombotic medications before high-risk ERCP procedures is a concern.
  • Optimizing periprocedural antithrombotic management is essential and can serve as a target for quality improvement initiatives.