Endoscopic Retrograde Cholangiopancreatography Related Bleeding Complication and Easy Management

Abstract

Aim:Endoscopic retrograde cholangiopancreatography (ERCP) has serious complications such as pancreatitis, perforation, cholangitis and bleeding. Our aim is to raise awareness about bleeding complication and management also to evaluate effectiveness of our approach.Methods:We analyzed medical records of 288 patients who underwent ERCP for the first time with successful endoscopic sphincterotomy between January 1, 2016 and March 31, 2019. Nineteen patients who developed bleeding complication during or after the procedure were evaluated.Results:Bleeding occurred in fifteen (5.2%) patients during the procedure and in four (1.4%) after the procedure. Of the 19 patients with bleeding, 12 (63.2%) had a comorbid condition. Presence of a comorbidity and pre-cut with needle-knife papillotome in cautery cut mode were associated with bleeding complication. Single comorbidity was not significant in terms of bleeding.Conclusion:Comorbidities that may cause bleeding should be evaluated with a pro-active approach and ERCP should be performed after necessary treatments and precautions. While pre-cutting with needle-knife papillotome, fast cutting should not be done in cautery cut mode and operation should be continued with controlled coagulation mode. We assume that adrenaline injection and balloon tamponade are the easiest methods and first-choice approach.

Keywords

• endoscopic retrograde cholangiopancreatography
• bleeding
• endoscopic sphincterotomy
• adrenaline injection