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