European Radiology

, Volume 24, Issue 11, pp 2779–2786 | Cite as

Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome

  • Geert Maleux
  • Jurgen Bielen
  • Annouschka Laenen
  • Sam Heye
  • Johan Vaninbroukx
  • Wim Laleman
  • Peter Verhamme
  • Alexander Wilmer
  • Werner Van Steenbergen



To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality.

Materials and methods

From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected.


Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012).


Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival.

Key Points

Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding

The rate of rebleeding is acceptably low

Haemostatic disorders appear to significantly influence 30-day survival


Embolization Haemorrhage Gastrointestinal tract Endoscopy Iatrogenic 



The scientific guarantor of this publication is Professor Raymond Oyen, Head of the Department of Radiology, University Hospitals Leuven (Belgium). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Ms. Annouschka Laenen, PhD, kindly provided statistical advice for this manuscript. She is a co-author of this manuscript. Institutional Review Board approval was not required because it was a retrospective analysis. Written informed consent was not required for this study because it was a retrospective analysis. None of the study subjects or cohorts have been previously reported. Methodology: retrospective observational, performed at one institution.


  1. 1.
    Ferreira L, Baron T (2007) Post-sphincterotomy bleeding: who, what, when and how. Am J Gastroenterol 102:2850–2858PubMedCrossRefGoogle Scholar
  2. 2.
    Wilcox C, Canakis J, Mönkemüller K, Bondora A, Geels W (2004) Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection. Am J Gastroenterol 99:244–248PubMedCrossRefGoogle Scholar
  3. 3.
    Mutignani M, Seerden T, Tringali A, Feisal D, Perri V, Familiari P, Costamagna G (2010) Endoscopic hemostasis with fibrin glue for refractory postsphincterotomy and postpapillectomy bleeding. Gastrointest Endosc 71:856–860PubMedCrossRefGoogle Scholar
  4. 4.
    Kuran S, Parlak E, Oguz D, Cicek B, Disibeyaz S, Sahin B (2006) Endoscopic sphincterotomy-induced hemorrhage: treatment with heat probe. Gastrointest Endosc 63:506–511PubMedCrossRefGoogle Scholar
  5. 5.
    Cotton P, Lehman G, Vennes J, Geenen J, Russel R, Meyers W, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393PubMedCrossRefGoogle Scholar
  6. 6.
    Freeman M, Nelson D, Sherman S, Haber G, Herman M, Dorsher P, Moore J, Fennerty M, Ryan M, Shaw M, Lande J, Pheley A (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918PubMedCrossRefGoogle Scholar
  7. 7.
    So Y, Choi Y, Chung J, Jae H, Song S, Park J (2012) Selective embolization for post-endoscopic sphincterotomy bleeding: technical aspects and clinical efficacy. Korean J Radiol 13:73–81PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Boujaoudé J, Pelletier G, Fritsch J, Choury A, Lefebvre J, Roche A, Liguory C, Etienne J (1994) Management of clinically relevant bleeding following endoscopic sphincterotomy. Endoscopy 26:217–221PubMedCrossRefGoogle Scholar
  9. 9.
    Gottschalk U, Meyer D, Steinberg J (2006) Pseudoaneurysm of the left hepatic artery as a result of ERCP. Z Gastroenterol 44:329–332PubMedCrossRefGoogle Scholar
  10. 10.
    Loffroy R, Guiu B, Cercueil J, Lepage C, Latournerie M, Hillon P, Rat P, Ricolfi F, Krausé D (2008) Refractory bleeding from gastroduodenal ulcers: arterial embolization in high-operative-risk patients. J Clin Gastroenterol 42:361–367PubMedCrossRefGoogle Scholar
  11. 11.
    Aina R, Oliva V, Therasse E, Perrault P, Bui B, Dufresne M, Soulez G (2001) Arterial embolotherapy for upper gastroduodenal hemorrhage: outcome assessment. J Vasc Intervent Radiol 12:195–200CrossRefGoogle Scholar
  12. 12.
    Defreyne L, Vanlangenhove P, De Vos M, Pattyn P, Van Maele G, Decruyenaere J, Troisi R, Kunnen M (2001) Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage. Radiology 218:739–748PubMedCrossRefGoogle Scholar
  13. 13.
    Poultsides G, Kim C, Orlando R 3rd, Peros G, Hallisey M, Vignati P (2008) Angiographic embolization for gastroduodenal hemorrhage: safety, efficacy, and predictors of outcome. Arch Surg 143:457–461PubMedCrossRefGoogle Scholar
  14. 14.
    Yata S, Ihaya T, Kaminou T, Hashimoto M, Ohuchi Y, Umekita Y, Ogawa T (2013) Transcatheter arterial embolization of acute arterial bleeding in the upper and lower gastrointestinal tract with n-butyl-2-cyanoacrylate. J Vasc Interv Radiol 24:422–431PubMedCrossRefGoogle Scholar
  15. 15.
    Yamaguchi H, Wakiguchi S, Murakami G, Hata F, Hirata K, Shimada K, Kitamura S (2001) Blood supply to the duodenal papilla and the communicating artery between the anterior and posterior pancreaticoduodenal arterial arcades. J Hepatobiliary Pancreat Surg 8:238–244PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Geert Maleux
    • 1
    • 2
  • Jurgen Bielen
    • 1
    • 2
  • Annouschka Laenen
    • 3
    • 4
  • Sam Heye
    • 1
    • 2
  • Johan Vaninbroukx
    • 1
    • 2
  • Wim Laleman
    • 5
  • Peter Verhamme
    • 6
  • Alexander Wilmer
    • 7
  • Werner Van Steenbergen
    • 5
  1. 1.Department of RadiologyUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of Imaging & PathologyKU LeuvenLeuvenBelgium
  3. 3.Interuniversity Institute for Biostatistics and Statistical BioinformaticsKU LeuvenLeuvenBelgium
  4. 4.Universiteit HasseltHasseltBelgium
  5. 5.Department of HepatologyUniversity Hospitals LeuvenLeuvenBelgium
  6. 6.Department of Vascular MedicineUniversity Hospitals LeuvenLeuvenBelgium
  7. 7.Department of Intensive Care MedicineUniversity Hospitals LeuvenLeuvenBelgium

Personalised recommendations