Is routine placement of hemoclips during endoscopic retrograde cholangiopancreatography necessary for preventing...

This study aimed to investigate the necessity and safety of routinely placing prophylactic hemoclips at the duodenal papilla during endoscopic retrograde cholangiopancreatography to prevent delayed bleeding.

A retrospective analysis was conducted on the clinical data of 265 patients who underwent endoscopic retrograde cholangiopancreatography at the Department of Hepatobiliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from April 2021 to April 2025. The study focused on the impact of prophylactic hemoclip placement at the duodenal papilla during ERCP using a "small incision + dilation" technique with different sizes of dilation balloons. Patients were divided into an observation group (n = 109) and a control group (n = 156). The observation group received endoscopic retrograde cholangiopancreatography plus prophylactic hemoclip placement, while the control group received only endoscopic retrograde cholangiopancreatography. The study compared changes in amylase, alanine aminotransferase, aspartate aminotransferase, neutrophils, lymphocytes, red blood cells, and platelet counts at 3 h and 24 h post-procedure between the two groups. Additionally, the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, delayed bleeding, and gastrointestinal perforation, as well as the length of hospital stay, were analyzed.

The observation group had significantly higher 24-hour amylase and platelet levels compared to the control group (P < 0.05). Subgroup analysis based on the use of 0.6 cm, 0.8 cm, 1.0 cm, and 1.2 cm dilation balloons showed that, when comparing between groups, there were statistically significant differences in 24-hour amylase, lymphocyte, and red blood cell levels (P < 0.05). The 24-hour amylase levels, from highest to lowest, were: 0.6 cm, no balloon, 1.0 cm, 0.8 cm, and 1.2 cm. The 24-hour lymphocyte levels, from highest to lowest, were: 1.2 cm, 0.8 cm, no balloon, 1.0 cm, and 0.6 cm. The 24-hour red blood cell levels, from highest to lowest, were: 0.8 cm, 0.6 cm, no balloon, 1.2 cm, and 1.0 cm. Within the 0.6 cm subgroup, the observation group had significantly higher 24-hour amylase levels compared to the control group (P < 0.05), while no significant differences were observed in other subgroups.

For small and clearly defined bleeding sites during endoscopic retrograde cholangiopancreatography, the placement of endoscopic hemoclips is recommended to reduce the risk of postoperative bleeding and perforation. This method is convenient and effective. However, this study suggests that prophylactic hemoclip placement during dilation with diameters < 0.8 cm may lead to increased amylase levels and a higher risk of pancreatitis. Therefore, prophylactic hemoclip placement is not recommended when the dilation diameter is < 0.8 cm, unless it is necessary.