Biliary-pancreatic endoscopic and surgical procedures in patients under dual antiplatelet therapy: A single-center study

Aims: Despite the widespread use of dual antiplatelet therapy after coronary interventions, the optimal management of patients on these drugs undergoing surgical or endoscopic procedures is still unclear. As no data are available on the potential risk of bleeding in this setting, it was the aim of our study to report the outcome of our patients who underwent endoscopic sphincterotomy or biliary-pancreatic surgery while under dual antiplatelet therapy.

Patients and methods: We retrospectively analyzed the medical records of all patients, who underwent biliary-pancreatic surgery or ERCP with ES in our hospital (Departments of Gastroenterology and Surgery, Pforzheim Hospital, Germany) between January 2009 and July 2012. Patients under a dual antiplatelet therapy at the time of surgery/endoscopy were identified. Patient demographic, clinical, sonographic, endoscopic, surgical, and laboratory findings were collected.

Results: Nine patients underwent ERC with ES and basket/balloon stone/sludge extraction. In one patient emergency cholecystectomy due to severe cholecystitis was performed. One patient underwent pylorus preserving pancreaticoduodenectomy (PPPD) due to recurrent bleeding from a duodenal diverticulum despite repeated endoscopic hemostasis. In our series, ES and biliary-pancreatic surgery were safely performed in all patients on uninterrupted dual antiplatelet therapy with no evidence of perioperative or post-sphincterotomy bleeding.

Conclusion: In emergency, surgical and high-risk endoscopic procedures may be performed in patients on dual antiplatelet therapy. To our knowledge, this is the first report on the safety of biliary-pancreatic surgical and endoscopic procedures in this setting.