ERCP-Related Bleeding

Abstract

Clinically significant bleeding is an uncommon complication of diagnostic endoscopic retrograde cholangiopancreatography. But the endoscopists needs to be skilled at prevention and management. Post ERCP bleeding is most often seen following sphincterotomy. The overall risk of bleeding in patients undergoing sphincterotomy is approximately 1-2 percent. Most bleeding episodes are mild to moderate in severity. The risk of bleeding can be minimized by identifying patients at risk, correcting coagulation abnormalities and careful technique by skilled endoscopists in high-volume centers. Post-sphincterotomy bleeding often stops spontaneously and is rarely life-threatening, except in patients with a bleeding diathesis. Most clinically relevant bleedings can be managed with medical treatment and/or endoscopic therapy, which should be performed without delay in patients who have immediate bleeding. Endoscopic therapy options include epinephrine injection, hemostatic clips, thermal therapy and placement of full covered self-expandable metal stents. Angiography or surgery is usually reserved for patients with refractory bleeding and is rarely required.

Adverse Outcomes of Endoscopic Retrograde Cholangiopancreatography at Gastroenterology and Hepatology Centers in Sulaymaniyah and Duhok City

“…Our study showed that post-ERCP bleeding was present in 3 (1.5%) patients, two patients with immediate bleeding, and one patient with delayed bleeding, and the bleeding severity was distributed into mild, moderate, and severe in (0.5%, 0.5%, 0.5%, respectively). These findings are close to reports of the Yildirim study in Turkey, which stated that the bleeding following ERCP occurred in one to two percent of patients who underwent ERCP with different intensities (28) . The current study found 3 (1.5%) patients were also detected post-ERCP perforation.…”