Comparing endoscopic intervention against fully covered self-expanding metal stent placement for post-endoscopic sphincterotomy bleed (CEASE Study)

Abstract

Background and study aims: Limited data exist for the use of fully covered self-expanding metal stent (FCSEMS) as an intervention for immediate bleeds post-endoscopic sphincterotomy (ES) after primary endoscopic intervention failure or to reduce the number of delayed bleeding events in patient with increased risk of bleeding post-ES. Patients and methods: We evaluated a retrospective cohort of individuals who had ES performed from 2011 to 2014. A total of 700 patients were identified with 67 patients having post-ES bleeding. The FCSEMS treatment group included 23 patients and the non-FCSEMS treatment group included 44 patients. The primary end point was rate of change of Hgb at 72 hours after ES in the FCSEMS group and the primary endoscopic intervention-only group. A comparison also was made between the FCSEMS and non-FCSEMS group with regards to proportion of coagulopathy and number of delayed bleeding events. Results: The FCSEMS treatment group had a lower bleeding rate at 72 hours (0.66 g/dL vs 1.98 g/dL P < 0.001), increased proportion of patients at high risk of bleeding (40 % vs 9 % P value 0.008), and increased frequency of bleeding events that were moderately severe (52 % vs 9 % P = 0.0002) compared to the non-FCSEMS treatment group. The FCSEMS group included 9 patients at increased risk of bleeding and no patients with delayed bleed compared to the non-FCSEMS group, in which all 4 patients at increased risk of bleeding developed a delayed bleed. Conclusion: FCSEMS can provide homeostasis after primary endoscopic intervention failure, thus reducing the need for high-risk procedures. FCSEMS can reduce delayed bleeding events in patients at high risk of post-ES bleeding.

Management of postendoscopic sphincterotomy bleeding with fully covered self‐expanding metal stent

“…There is currently no consensus on when to remove the FCSEMS placed for hemostasis. In most studies, the stent was removed after 1 to 4 weeks, although Cochrane and Schlepp described a longer duration of 88 days . In our series, the stent was removed after an average of 32.2 days.…”

“…Most recently, Cochrane and Schlepp conducted a retrospective nonrandomized controlled comparative study between traditional endoscopic intervention and FCSEMS in patients with post‐ES bleeding. They concluded that FCSEMS can provide hemostasis after the failure of primary endoscopic intervention and reduce the need for high‐risk procedures such as embolization and surgery . Another advantage of this treatment is the simultaneous and effective drainage of the bile duct, especially when occluded with blood clots …”

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

“…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.…”

Treatment for postendoscopic sphincterotomy bleeding with fully covered self‐expanding metal stent: A feasible and safe method

“…Cochrane and Schlepp reported a study that compared the effects of FCSEMS and conventional endoscopic therapy for patients with post‐ES bleeding. It shows that FCSEMS can provide hemostasis after primary endoscopic intervention failure, which in turn avoids the more invasive treatment strategies, including TAE and surgery.…”