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Delayed hemorrhage following endoscopic retrograde sphincterotomy for choledocholithiasis
C F Gholson1, D Favrot, B Vickers
1Department of Medicine, Louisiana State University School of Medicine, Shreveport 71130-3932, USA.
Digestive Diseases and Sciences
|May 1, 1996
Summary
Delayed hemorrhage after endoscopic sphincterotomy (ES) is a severe complication. This study found it occurred in 2% of patients, often requiring transfusion or surgery.
Area of Science:
- Gastroenterology
- Endoscopy
- Hemorrhagic Complications
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is a common procedure.
- Understanding post-procedure hemorrhage is crucial for patient safety.
Observation:
- A review of 476 ERCP procedures identified 250 patients who underwent ES.
- Five patients (2%) experienced post-ERCP hemorrhage.
- Delayed hemorrhage occurred in three patients, 20-48 hours post-procedure, presenting as melena.
Findings:
- Delayed post-sphincterotomy hemorrhage is a significant complication, affecting 2% of patients.
- This complication often presents with melena and may necessitate blood transfusions (2-6 units) or surgical intervention.
- Immediate bleeding was self-limited and resolved with endoscopic epinephrine injection.
Implications:
- Clinicians should consider the risk of delayed hemorrhage when planning ERCP with ES, especially for outpatient procedures.
- Awareness of this complication is vital for timely diagnosis and management.
- Further research may explore preventative strategies for delayed post-ERCP bleeding.