Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis

Nakaji, So; Hirata, Nobuto; Matsui, Hiroki; Shiratori, Toshiyasu; Kobayashi, Masayoshi; Yoshimura, Shigenobu; Kanda, Keisuke; Kawamitsu, Natsuki; Harasawa, Hisato

doi:10.1055/a-0587-4470

Cited by 16 publications

(15 citation statements)

References 19 publications

(30 reference statements)

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“…The underlying principles of management depend on a balance between the risk of hemorrhage due to the procedure if The optimal timing for restarting antithrombotic therapy after ERCP will depend on the perceived risk of post-procedural bleeding and of thrombosis. Patients who experience significant intraprocedural bleeding are at increased risk of delayed bleeding [209], and the interval for reinstatement may be prolonged accordingly. It is important that a management plan for reinstatement of antithrombotic therapy is documented in all cases, and also that patients are made aware of the risk of delayed hemorrhage once that therapy is reinstated.…”

Section: Management Of Anticoagulants and Antiplatelet Agents For Ercpmentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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Main Recommendations Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.Weak recommendation, low quality evidence.

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Section: Management Of Anticoagulants and Antiplatelet Agents For Ercpmentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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“…Several studies reported hemodialysis as an independent risk factor for EST bleeding, however, this is not accepted by the major endoscopy society guidelines[3,8,9]. Platelet dysfunction due to uremic toxins, accumulation of heparin due to decreased renal clearance, alterations in the vessel wall, anemia and adverse effects of the hemodialysis procedure are the possible mechanisms.…”

Section: Contraindications Of Biliary Estmentioning

confidence: 99%

Biliary endoscopic sphincterotomy: Techniques and complications

Köksal

Eminler

Parlak

2018

WJCC

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Biliary endoscopic sphincterotomy (EST) refers to the cutting of the biliary sphincter and intraduodenal segment of the common bile duct following selective cannulation, using a high frequency current applied with a special knife, sphincterotome, inserted into the papilla. EST is either used solely for the treatment of diseases of the papilla of Vater, such as sphincter of Oddi dysfunction or to facilitate subsequent therapeutic biliary interventions, such as stone extraction, stenting, etc. It is a prerequisite for biliary interventions, thus every practitioner who performs endoscopic retrograde cholangiopancreatography needs to know different techniques and the clinical and anatomic parameters related to the efficacy and safety of the procedure. In this manuscript, we will review the indications, contraindications and techniques of biliary EST and the management of its complications.

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“…Several single-center studies have analyzed the risk factors for EST bleeding [3,15,[17][18][19]. Although most of these reports only included patients treated with warfarin, a few recent reports analyzed the risk factors for EST bleeding in patients treated with DOAC [9,10].…”

Section: Discussionmentioning

confidence: 99%

Direct Oral Anticoagulants Increase Bleeding Risk After Endoscopic Sphincterotomy: A Retrospective Study

Masuda

Koizumi

Nishino

et al. 2020

Preprint

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Background: Bleeding is a serious adverse event of endoscopic sphincterotomy (EST). However, the risk of EST bleeding between direct oral anticoagulant (DOAC) users and those who received no antithrombotic agents has not been clarified. This study analyzed the risk factors for bleeding after EST in patients on DOAC and evaluated the Japan Gastroenterological Endoscopy Society (JGES) guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.Methods: We retrospectively analyzed 524 patients treated with EST who received DOAC or no antithrombotic drug from May 2016 to August 2019. We investigated the risk factors for bleeding. Cessation and resumption of DOAC treatment were determined according to the JGES guidelines, although DOAC cessation or heparin replacement was determined by the attending physician. Results: The number of patients on DOAC (DOAC group) and those without antithrombotic drug (no-drug group) were 42 (8.0%) and 482 (92.0%), respectively. DOAC was discontinued for <2 days in 24 (57.2%) patients and for ≥2 days in 18 (42.8%) patients. Of the 524 patients, 21 (4.0%) had EST bleeding. The bleeding rate was significantly higher in the DOAC group (14.3%, 6/42). Multivariate analysis showed that bleeding occurs more frequently in patients on DOAC, patients with low platelet counts (<100,000/µl), and elderly patients (>80 years old).Conclusions: DOAC treatment, low platelet count, and old age (>80 years old) are significant risk factors for EST bleeding. Although the bleeding incidence increased in patients on DOAC, which was discontinued according to the JGES guidelines, successful hemostasis was achieved with endoscopy in all cases with bleeding, and no thrombotic events occurred after cessation of DOAC. Thus, the JGES guidelines are acceptable.

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Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis

Cited by 16 publications

References 19 publications

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Biliary endoscopic sphincterotomy: Techniques and complications

Direct Oral Anticoagulants Increase Bleeding Risk After Endoscopic Sphincterotomy: A Retrospective Study

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