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Is there a safer electrosurgical current for endoscopic sphincterotomy in patients with liver cirrhosis?

Gibt es einen sichereren elektrochirurgischen Strom für die endoskopische Sphinkterotomie bei Patienten mit Leberzirrhose?

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Summary

Background

Endoscopic sphincterotomy has a higher risk of bleeding in patients with cirrhosis. Advanced Child stage and coagulopathy are well-known risk factors. We aimed to determine the role of electrosurgical currents in the development of endoscopic sphincterotomy bleeding in cirrhotic patients.

Methods

The study was a retrospective observational study and included 19,642 patients who underwent endoscopic retrograde cholangiopancreatography between 2004 and 2013. The incidence of endoscopic sphincterotomy bleeding in cirrhotic patients who underwent sphincterotomy after 2009 with an electrosurgical generator applying alternating current in the pulse cut mode (Group 2) was compared with a historical control group who underwent endoscopic sphincterotomy between 2004 and 2009 via blended current (Group 1).

Results

Group 1 included 15 patients (six women, nine men, mean age: 62.2 ± 12.9 years). Group 2 included 14 patients (six women, eight men, mean age: 63.6 ± 16.9 years). There was no statistically significant difference between the demographic and clinical characteristics of the two groups. Endoscopic sphincterotomy bleeding was observed in three patients in Group 1 (two endoscopic bleeding and one clinically significant bleeding) and none of the patients in Group 2 (p = 0.77). There were no cases of perforation or pancreatitis in both groups. One patient in Group 2 developed cholangitis.

Conclusions

Endoscopic sphincterotomy bleeding is less frequently observed in patients with cirrhosis who underwent sphincterotomy with alternating mixed current in the pulse cut mode compared with those with blended current.

Zusammenfassung

Grundlagen

Die endoskopische Sphinkterotomie hat bei Patienten mit Leberzirrhose ein erhöhtes Blutungsrisiko. Ein höheres Stadium nach Child und eine Koagulopathie sind gut bekannte Risikofaktoren. Unser Ziel war es, bei Patienten mit Leberzirrhose die Rolle der verschiedenen elektrochirurgischen Stromarten bei einer durch endoskopische Sphinkterotomie ausgelösten Blutung zu untersuchen.

Methodik

Bei unserer Studie handelt es sich um eine retrospektive Beobachtungsstudie. Sie schließt 19.642 Patienten, die zwischen 2004 und 2013 eine ERCP hatten, ein. Die Inzidenz einer bei einer endoskopischen Sphinkterotomie auftretenden Blutung wurde bei zirrhotischen Patienten, die nach 2009 (Gruppe 2) ihre Sphinkterotomie (bei der ein elektrochirurgischer Generator verwendet wurde, der mit der Pulse Cut Methode Wechselstrom applizierte) hatten, untersucht und mit der Blutungsinzidenz einer historischen Kontrollgruppe verglichen, bei denen die Sphinkterotomie in den Jahren zwischen 2004 und 2009 (Gruppe 1) durchgeführt und bei denen ein Mischstrom angewandt wurde.

Ergebnisse

Die Gruppe 1 bestand aus 15 Patienten (6 Frauen, 9 Männer, Mittleres Alter 62,2 ± 12,9 Jahre), die Gruppe 2 aus 14 Patienten (6 Frauen, 8 Männer; Mittleres Alter 63,6 ± 16,9 Jahre). Es gab keine statistisch signifikanten Unterschiede der demographischen und klinischen Charakteristika beider Gruppen. Bei 3 Patienten der Gruppe 1 wurde eine Blutung bei der endoskopischen Sphinkterotomie beobachtet: bei 2 davon nur endoskopisch, bei einem war die Blutung klinisch wirksam. Bei Gruppe 2 wurde gar keine Blutung beobachtet (p = 0,77). Bei keinem Patienten trat eine Perforation oder eine Pankreatitis ein. Ein Patient der Gruppe 2 entwickelte eine Cholangitis.

Schlussfolgerungen

Bei Patienten mit Leberzirrhose traten Blutungen bei der endoskopischen Sphinkerotomie weniger häufig auf, wenn gemischter Wechselstrom in der Pulse Cut Methode verwendet wurde als beim Einsatz von gemischtem Strom.

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The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Correspondence to Aydın Şeref Köksal.

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Parlak, E., Köksal, A., Öztaş, E. et al. Is there a safer electrosurgical current for endoscopic sphincterotomy in patients with liver cirrhosis?. Wien Klin Wochenschr 128, 573–578 (2016). https://doi.org/10.1007/s00508-014-0677-3

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  • DOI: https://doi.org/10.1007/s00508-014-0677-3

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