[Surgical therapy of hemorrhage after endoscopic sphincterotomy. Indications and technique]

Postinterventional bleeding occurs in 2.5% after endoscopic sphincterotomy (EST). It is the most frequent complication of this technique. According to the world literature the mortality of post-EST-bleeding averages 10%. According to a review of the world literature patients are often operated upon too rarely and too late. Direct surgical interventions at the Vaterian papilla should be omitted because of the danger of post-operative pancreatitis. From our point of view laparotomy and ligation of the gastroduodenal artery are recommended if periampullary injection of epinephrine fails to control the bleeding. The cessation of the bleeding should be controlled by intraoperative endoscopy. During the same surgical intervention the underlying disease for EST, e.g. common bile duct stones, ought to be treated surgically to prevent a new bleeding episode. If the underlying disease was already cured or in case of inoperability, selective embolization of the gastroduodenal artery presents an alternative option.