Usefulness of fully covered self-expandable biliary metal stents for the treatment of post-sphyncterotomy ERCP bleeding

Conthe, Andrés; Nogales, Óscar; Flores, C Martinez; Lledó, J García; Rayón, Laura; Carazo, L Pérez; Mulas, Seila García; Ibáñez, María López; Hernández, J; Merino, Beatriz

doi:10.17235/reed.2019.6393/2019

Cited by 2 publications

(3 citation statements)

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“…To prevent additional tissue injury during hemostasis in HD patients who are at greater risk of bleeding, covered selfexpandable metal stent placement might be useful. 21,22 Despite the insights provided by our study, there are some limitations to consider. First, some candidates were excluded from this study because of deficiencies in their available data.…”

Section: Discussionmentioning

confidence: 83%

“…Moreover, in cases where post‐ES bleeding had already occurred, the rebleeding rate (45%: 9/20) was higher than that of past reports (5.9%: 8/136 and 27.0% 4/30), and repeat hemostasis is often required, with delayed wound healing and prolonged bleeding likely caused by factors such as malnutrition, peripheral circulatory failure, and immunodeficiency. To prevent additional tissue injury during hemostasis in HD patients who are at greater risk of bleeding, covered self‐expandable metal stent placement might be useful …”

Section: Discussionmentioning

confidence: 99%

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Predictive model of bleeding following endoscopic sphincterotomy for the treatment of choledocholithiasis in hemodialysis patients: A retrospective multicenter study

et al. 2020

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Background and Aim: Although hemodialysis (HD) is a strong risk factor for postendoscopic sphincterotomy (ES) bleeding, additional risk factors in HD patients remain unclear. There is no model for predicting post-ES bleeding risk in HD patients. Therefore, we conducted a retrospective multicenter study to reveal these risk factors and develop a predictive model of post-ES bleeding in HD patients. Methods: We retrospectively reviewed the medical records of HD patients who underwent ES at eight hospitals between January 2006 and December 2016, with post-ES bleeding as the main outcome measure. Univariate analyses were performed to extract possible risk factors for post-ES bleeding. Factors that were clinically important and statistically significant in our univariate analyses were then included in our logistic regression analysis for the development of a multivariate predictive model of post-ES bleeding. This predictive model was visualized using a predictive nomogram. Results: Post-ES bleeding occurred in 20 (16.3%) of 123 HD patients. Based on clinically important factors and the results of our univariate analyses, platelet count, prothrombin time (international normalized ratio), and HD duration were included in our predictive model of post-ES bleeding. Receiver operating characteristic analysis found that this model had an area under the curve of 0.715 (95% confidence interval, 0.609-0.822). We developed a predictive nomogram based on these results. Conclusions: We demonstrated that post-ES bleeding is more common in HD patients than in the general population and succeeded in constructing a predictive model that can effectively identify HD patients at risk of post-ES bleeding.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Predictive model of bleeding following endoscopic sphincterotomy for the treatment of choledocholithiasis in hemodialysis patients: A retrospective multicenter study

et al. 2020

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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].…”

Section: Patient Characteristics Are Shown Inmentioning

confidence: 99%

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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Usefulness of fully covered self-expandable biliary metal stents for the treatment of post-sphyncterotomy ERCP bleeding

Cited by 2 publications

References 0 publications

Predictive model of bleeding following endoscopic sphincterotomy for the treatment of choledocholithiasis in hemodialysis patients: A retrospective multicenter study

Predictive model of bleeding following endoscopic sphincterotomy for the treatment of choledocholithiasis in hemodialysis patients: A retrospective multicenter study

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

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