Incidence, Predictors, and Outcomes of Clinically Significant Post-Endoscopic Retrograde Cholangiopancreatography

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Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
07:36

Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery

Published on: February 10, 2023

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Kirles Bishay1,2, Yibing Ruan3,4, Alan N Barkun5

  • 1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

The American Journal of Gastroenterology
|November 4, 2024
PubMed

Insights

Clinically significant post-ERCP bleeding (CSPEB) affects 1.5% of procedures, particularly after interventions like sphincterotomy. Antithrombotic medications significantly increase CSPEB risk, highlighting the need for careful management.

Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Hepatobiliary Medicine

Background:

  • Clinically significant post-ERCP bleeding (CSPEB) is a frequent complication.
  • Current risk estimates for CSPEB are limited.
  • This study aimed to identify risk factors and outcomes associated with CSPEB.

Purpose of the Study:

  • To determine the incidence and risk factors of clinically significant post-ERCP bleeding (CSPEB).
  • To evaluate the outcomes and associated factors following CSPEB.
  • To assess the impact of antithrombotic medications on CSPEB risk.

Main Methods:

  • Multicenter prospective analysis of ERCP data from 2018-2024 with 30-day follow-up.
  • CSPEB defined by specific bleeding criteria (hemoglobin drop, transfusion, re-evaluation, or prolonged admission).
  • Firth logistic regression used to identify risk factors, reporting odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

  • CSPEB occurred in 1.5% of 8,517 ERCPs, with 2.3% after higher-risk interventions.
  • Antithrombotic agents including P2Y 12 inhibitors, warfarin, dabigatran, rivaroxaban, and apixaban were significantly associated with CSPEB.
  • Intraprocedural bleeding during sphincterotomy and concomitant cardiorespiratory events post-CSPEB were also associated.

Conclusions:

  • The risk of antiplatelet-related CSPEB may be underestimated.
  • Suboptimal management of antithrombotic medications before high-risk ERCP was observed.
  • Optimizing periprocedural antithrombotic management is crucial and can be a target for quality improvement initiatives.
Abstract

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