Is insertion of a plastic stent better and safer than epinephrine injection in post sphincterotomy bleeding?

Schmitz, Daniel; Weller, Niels; Doll, Matthias; Werle, Stephan; C, Mees; Prinz, P; John, Barbara E.; Schmidt, D; Günther, Andreas; Weiß, Christel; Rudi, Jochen

doi:10.1097/meg.0000000000001620

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…Recent studies showed that metal stent could treat post-ERCP bleeding by compression [34][35][36]. Plastic stent insertion could also be an effective, alternative option for post-ERCP bleeding in patients, shown in one previous study [37]. Thus, we tried to analyze if temporary biliary stent insertion during ERCP could prevent post-ERCP bleeding in our ESRD patients.…”

Section: Patient Characteristics Are Shown Inmentioning

confidence: 97%

A strategy to prevent post-endoscopic retrograde cholangiopancreatography bleeding in end-stage renal disease patients

Wang

Lee

et al. 2023

Preprint

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Background: End-stage renal disease (ESRD) is a risk factor of post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding, which may prolong hospitalization or increase the mortality rate. Hemodialysis is known to correct platelet dysfunction from ESRD but whether it can decrease post-ERCP bleeding is still uncertain. Endoscopic papillary balloon dilation (EPBD) had been reported to decrease post-ERCP bleeding but lacks evidence on whether replacing endoscopic sphincterotomy (EST). Aims: To explore the predictive factors of post-ERCP bleeding and if hemodialysis could decrease post-ERCP bleeding in ESRD patients. Furthermore, to investigate if the post ERCP bleeding rate, the severity of hemorrhage, and difficulty of treatment differ between EST and EPBD. Materials and Methods: This retrospective study acquired patient data from Chang Gung Memorial Hospitals by using Chang Gung Research Database (CGRD) from January 1, 2010, to June 30, 2020. We enrolled ESRD patients who underwent EST or EPBD on the naïve major papilla. First, we analyze the protective factors to prevent post-ERCP bleeding. And to compare the severity of post-ERCP bleeding and difficulty of hemostatic treatment between EST or EPBD with bleeding. Results: Total 580 patients enrolled, and we found hemodialysis significantly decreased post ERCP bleeding in the group of eGFR < 15 mL / min / 1.73m2 (p = 0.039, OR = 0.65, 95% CI: 0.43–0.98). Although the bleeding incidence was similar between EST and EPBD groups, there were significantly more patients in the EST bleeding group who required invasive hemostasis procedures (p = 0.001, N = 30/41, 73.17%). Patients who required two or more hemostasis procedures, such as trans-arterial embolization or endoscopic hemostasis, were exclusively in the EST bleeding group. Conclusion: Hemodialysis can decrease post ERCP bleeding rate in patients with eGFR < 15 mL / min / 1.73m2. Although the bleeding incidence is similar between EST and EPBD in ESRD patients, hemostatic treatments were more complicated in EST with bleeding than in EPBD.

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Section: Patient Characteristics Are Shown Inmentioning

confidence: 97%

A strategy to prevent post-endoscopic retrograde cholangiopancreatography bleeding in end-stage renal disease patients

Wang

Lee

et al. 2023

Preprint

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Comparison of Endoscopic Hemostasis for Endoscopic Sphincterotomy Bleeding between a Novel Self-Assembling Peptide and Conventional Technique

Uba

Ogura

Ueno

et al. 2022

JCM

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Introduction: Recently, a novel self-assembling peptide hemostatic gel has become available in Japan. However, the safety and efficacy of this novel self-assembling peptide hemostatic gel remain unclear for bleeding after EST. The aim of this study was to evaluate the safety and efficacy of a novel self-assembling peptide hemostatic gel for bleeding after EST, and to perform a comparison to a conventional endoscopic hemostasis technique. Method: This retrospective study was carried out between January 2019 and October 2022. Patients who developed bleeding associated with EST were enrolled. The patients were divided into two groups based on the hemostasis technique used: a conventional hemostasis technique (Group A) or a novel self-assembling peptide hemostatic gel hemostasis technique (Group B). Result: A total of 62 patients (Group A, n = 36; Group B, n = 26) were included. Endoscopic hemostasis was initially obtained in 72.2% (26/32) of patients in Group A and in 88.4% (23/26) of patients in Group B, which was not significantly different (p = 0.1320). However, the procedure time was significantly shorter in Group B (mean, 9.38 min) compared with Group A (mean, 15.4 min) (p = 0.0103). There were no significant differences in the severity of bleeding between the two groups (p = 0.4530). Post-EST bleeding was observed in six patients (Group A, n = 4; Group B, n = 2). Adverse events were more frequently observed in Group A (n = 12) than in Group B (n = 1) (p = 0.0457). Conclusions: PuraStat application for EST bleeding might be safe and effective, and is comparable to the conventional endoscopic hemostasis technique, although further prospective randomized trials are needed.

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Is insertion of a plastic stent better and safer than epinephrine injection in post sphincterotomy bleeding?

Cited by 2 publications

References 27 publications

A strategy to prevent post-endoscopic retrograde cholangiopancreatography bleeding in end-stage renal disease patients

A strategy to prevent post-endoscopic retrograde cholangiopancreatography bleeding in end-stage renal disease patients

Comparison of Endoscopic Hemostasis for Endoscopic Sphincterotomy Bleeding between a Novel Self-Assembling Peptide and Conventional Technique

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