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Sphincterotomy during endoscopic biliary drainage in cholangitis with sepsis-induced coagulopathy increases bleeding

Yasuhisa Hiroshima1, Ryota Sagami2, Naosuke Kuraoka3

  • 1Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|February 8, 2026
PubMed

Insights

Endoscopic sphincterotomy (EST) increases bleeding risk in acute cholangitis (AC) patients with sepsis-induced coagulopathy (SIC). Biliary drainage without EST minimizes bleeding while maintaining clinical outcomes.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endoscopic Procedures

Background:

  • Acute cholangitis (AC) is a severe condition requiring urgent biliary drainage.
  • Endoscopic biliary drainage (EBD) with endoscopic sphincterotomy (EST) is common but carries bleeding risks, especially in patients with sepsis-induced coagulopathy (SIC).

Purpose of the Study:

  • To assess adverse events (AEs) and clinical outcomes of EBD with or without EST in AC patients with SIC.

Main Methods:

  • Retrospective multicenter cohort study.
  • Propensity score matching used to compare outcomes between EST and non-EST groups.
  • Primary endpoint: AE rate difference; Secondary endpoints: clinical outcomes.

Main Results:

  • Higher AE incidence, particularly bleeding, in the EST group (16.7% vs. 1.8%).
  • Post-ERCP pancreatitis (PEP) incidence did not differ significantly between groups (4.2% vs. 1.2%).
  • No significant difference in clinical success or 28-day survival rates.

Conclusions:

  • EST significantly elevates bleeding risk in AC patients with SIC.
  • EBD without EST effectively minimizes bleeding risk without compromising biliary drainage or clinical outcomes.
Abstract

Keywords:
Acute cholangitisCoagulopathyEndoscopic biliary drainageEndoscopic sphincterotomy

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