Endoscopic Hemostasis in Sphincterotomy-Induced Hemorrhage: Its Efficacy and Safety

Introduction

Endoscopic biliary sphincterotomy (ES) is regarded as a fundamental procedure amongst endoscopic therapeutic interventions for various pancreaticobiliary diseases. However, complications, such as hemorrhage, pancreatitis or perforation of the duodenal wall, cannot always be avoided and occur in approximately 10 - 13 % of these procedures [1] [2] [3] [4] [5].

Bleeding, one of the most frequent complications, occurs in 0.5 to 12 % of the procedures [6] [7] [8] [9], and ranges in severity from self-limited mucosal oozing to life-threatening arterial bleeding. Since the introduction of endoscopic hemostasis with epinephrine or alcohol, the morbidity and mortality of ES-induced hemorrhage have declined. There have been many reports regarding the efficacy of endoscopic hemostasis [10] [11]; however, most of them dealt only with the effectiveness of the treatment and scarcely mentioned its safety. Moreover, there were few, well organized prospective studies aimed at identifying the risk factors for ES-induced hemorrhage.

In the present study, we prospectively investigated the risk factors for ES-induced hemorrhage from three aspects: patient factors, ampulla of Vater factors, and technical factors. We also evaluated the safety as well as the effectiveness of endoscopic hemostasis.

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