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Factors associated with delayed hemorrhage after endoscopic sphincterotomy: Japanese large single-center experience

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Hemorrhage is one of the serious adverse events of endoscopic sphincterotomy (EST). However, the risk factors for delayed hemorrhage after EST have not been clarified. The aim of this study was to examine the risk factors for delayed hemorrhage after EST.

Methods

Consecutive patients who underwent EST between January 2011 and December 2015 were analyzed retrospectively. The incidence, treatment outcomes, and risk factors for delayed hemorrhage were evaluated. Delayed hemorrhage was defined as symptomatic hemorrhage occurring 24 h after an endoscopic procedure.

Results

After analyzing 1113 patients who underwent EST, delayed hemorrhage was seen to occur in 30 (2.7%) patients. The median period before presentation of delayed hemorrhage was 2 days (range 1–6) after EST, and its severity was mild in four, moderate in 20, and severe in six patients. All patients with delayed hemorrhage received successful endoscopic hemostasis. Univariate analysis showed that delayed hemorrhage occurred more frequently in patients with hemodialysis (p = 0.013), heparin replacement of antithrombotic agents (p = 0.012), or early hemorrhage occurring just after EST (p < 0.001). Among these, hemodialysis (OR 6.44, 95% CI 1.67–24.8; p = 0.007), heparin replacement (OR 3.76, 95% CI 1.42–9.98; p = 0.008), and early hemorrhage (OR 4.35, 95% CI 1.90–9.96; p < 0.001) proved to be independent risk factors for delayed hemorrhage on multivariate analysis.

Conclusions

The incidence of delayed hemorrhage after EST was 2.7%. Hemodialysis, heparin replacement, and early hemorrhage were the risk factors for delayed hemorrhage.

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Acknowledgements

We would like to thank all of the participating patients.

Authors’ contribution

SI contributed to acquisition, analysis, and interpretation of data, and wrote the initial draft of the manuscript. AK designed the study. AK and TK critically reviewed the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Center for Gastroenterology, Teine-Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan

    Satoshi Ikarashi, Akio Katanuma, Toshifumi Kin, Kuniyuki Takahashi, Kei Yane, Itsuki Sano, Hajime Yamazaki & Hiroyuki Maguchi

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  1. Satoshi Ikarashi
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  2. Akio Katanuma
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  3. Toshifumi Kin
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  4. Kuniyuki Takahashi
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Correspondence to Akio Katanuma.

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Ikarashi, S., Katanuma, A., Kin, T. et al. Factors associated with delayed hemorrhage after endoscopic sphincterotomy: Japanese large single-center experience. J Gastroenterol 52, 1258–1265 (2017). https://doi.org/10.1007/s00535-017-1347-9

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  • DOI: https://doi.org/10.1007/s00535-017-1347-9

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