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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(03): E157-E164
DOI: 10.1055/s-0042-120225
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Safety and efficacy of minimal biliary sphincterotomy with papillary balloon dilation (m-EBS+EPBD) in patients using clopidogrel or anticoagulation

Shaffer R. S. Mok
1   Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, 501 Fellowship Rd, Suite 101, Mt. Laurel, NJ 08054
,
Murtaza Arif
2   Geisinger Health Systems, Department of Gastroenterology and Nutrition, 100 N Academy Ave, Danville, PA 17822
,
David L Diehl
2   Geisinger Health Systems, Department of Gastroenterology and Nutrition, 100 N Academy Ave, Danville, PA 17822
,
Harshit S Khara
2   Geisinger Health Systems, Department of Gastroenterology and Nutrition, 100 N Academy Ave, Danville, PA 17822
,
Henry C Ho
1   Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, 501 Fellowship Rd, Suite 101, Mt. Laurel, NJ 08054
,
Adam B Elfant
1   Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, 501 Fellowship Rd, Suite 101, Mt. Laurel, NJ 08054
› Author Affiliations
Further Information

Publication History

submitted 26 July 2016

accepted after revision 10 October 2016

Publication Date:
09 March 2017 (online)

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Comment on:

Endoscopy International Open – recently publishedEndoscopy 2017; 49(04): 407-408
DOI: 10.1055/s-0043-104129

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic biliary sphincterotomy (EBS) or endoscopic papillary balloon dilation (EPBD) are common techniques of biliary decompression. Potential risks include gastrointestinal hemorrhage, which can be increased by antiplatelet agents, anticoagulants (AC) and/or novel oral anticoagulants (NOACs) (ie. apixaban, dabigatran and rivaroxaban).

The study aim is to evaluate the safety/efficacy of an alternative technique, minimal-EBS plus EPBD (m-EBS + EPBD), in individuals for whom clopidogrel, AC, and/or NOACs cannot be interrupted due to high cardiovascular or thromboembolic risk.

Patients and methods Patients undergoing m-EBS + EPBD while taking clopidogrel and/or AC were retrospectively evaluated at two United States tertiary care centers for efficacy, GIB and procedure-related, cardiovascular and thromboembolic adverse events (AE).

Results Ninety-five patients were identified [55 = clopidogrel and 45 = AC (31.1 % NOACs)]. The main indication for ERCP was choledocholithiasis (34 %). 100 % clinical improvement and 97.9 % endoscopic success were found. The incidence of AE was 5.3 %. There was a 4.2 % incidence of gastrointestinal hemorrhage (2 cases requiring endoscopic intervention). Both severe gastrointestinal hemorrhages also experienced the cases of post-ERCP pancreatitis, and 2 /3 of cholangitis (all aspirin + AC). There was 1cardiovascular event (non-ST elevation myocardial infarction), and no thromboembolic events.

Conclusions Minimal-EBS + EPBD is an effective and safe therapy with an incidence of gastrointestinal hemorrhage of 4.2 %, (2.1 % requiring endoscopic intervention), for patients on clopidogrel and/or AC, with a high risk for cardiovascular/thromboembolic events.

 

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