BACKGROUND AND AIMS: Hemorrhage is one of the most common complications associated with endoscopic sphincterotomy (EST). Although most hemorrhage occurs immediately after EST, delayed hemorrhage may occur, even several days after EST. We analyzed the incidence, clinical features, treatment and risk factors for delayed hemorrhage following EST. METHODS: The medical records of 1549 patients who underwent EST between January 2000 and December 2006 were reviewed retrospectively. Delayed hemorrhage was defined as hemorrhage that developed 24 h after EST. RESULTS: Of the 1549 patients who underwent EST, early hemorrhage during the procedure occurred in 45 patients (2.9%) and delayed hemorrhage occurred in 20 patients (1.3%). The time interval between EST and delayed hemorrhage was 4.8 +/- 3.2 days (range, 1-15 days). Major hemorrhage developed in 80% of the patients with delayed hemorrhage. The mean decrease of hemoglobin was 3.5 +/- 1.9 g/dL. The presenting symptoms of delayed hemorrhage included melena (80%), postural hypotension (80%), resting tachycardia (45%) and acute cholangitis (20%). All bleeding was successfully controlled by endoscopic treatment. Based on multivariate analysis, chronic kidney disease (CKD), hypertension and ischemic heart disease (IHD) were significant risk factors for delayed hemorrhage. CONCLUSION: Complete control of intra-procedural bleeding is an important step in the prevention of late post-EST hemorrhage. Careful observation for delayed hemorrhage after EST, especially in patients with CKD, hypertension and IHD, is recommended.
BACKGROUND AND AIMS: Hemorrhage is one of the most common complications associated with endoscopic sphincterotomy (EST). Although most hemorrhage occurs immediately after EST, delayed hemorrhage may occur, even several days after EST. We analyzed the incidence, clinical features, treatment and risk factors for delayed hemorrhage following EST. METHODS: The medical records of 1549 patients who underwent EST between January 2000 and December 2006 were reviewed retrospectively. Delayed hemorrhage was defined as hemorrhage that developed 24 h after EST. RESULTS: Of the 1549 patients who underwent EST, early hemorrhage during the procedure occurred in 45 patients (2.9%) and delayed hemorrhage occurred in 20 patients (1.3%). The time interval between EST and delayed hemorrhage was 4.8 +/- 3.2 days (range, 1-15 days). Major hemorrhage developed in 80% of the patients with delayed hemorrhage. The mean decrease of hemoglobin was 3.5 +/- 1.9 g/dL. The presenting symptoms of delayed hemorrhage included melena (80%), postural hypotension (80%), resting tachycardia (45%) and acute cholangitis (20%). All bleeding was successfully controlled by endoscopic treatment. Based on multivariate analysis, chronic kidney disease (CKD), hypertension and ischemic heart disease (IHD) were significant risk factors for delayed hemorrhage. CONCLUSION: Complete control of intra-procedural bleeding is an important step in the prevention of late post-EST hemorrhage. Careful observation for delayed hemorrhage after EST, especially in patients with CKD, hypertension and IHD, is recommended.
Authors: Young Ho So; Young Ho Choi; Jin Wook Chung; Hwan Jun Jae; Soon-Young Song; Jae Hyung Park Journal: Korean J Radiol Date: 2011-12-23 Impact factor: 3.500
Authors: Woo Hyun Paik; Sang Hyub Lee; Dong Won Ahn; Ji Bong Jeong; Jin Woo Kang; Jun Hyuk Son; Ji Kon Ryu; Yong-Tae Kim Journal: Surg Endosc Date: 2018-03-06 Impact factor: 4.584
Authors: Yavuz Beyazit; Murat Kekilli; Ibrahim C Haznedaroglu; Ertugrul Kayacetin; Metin Basaranoglu Journal: World J Gastroenterol Date: 2011-09-21 Impact factor: 5.742