Clinical Journal of Gastroenterology

, Volume 11, Issue 3, pp 188–192 | Cite as

Successful endoscopic sphincterotomy for choledocholithiasis in a patient with severe hemophilia A and inhibitors

  • Ryo Sugiura
  • Masaki Kuwatani
  • Kazumichi Kawakubo
  • Itsuki Sano
  • Shin Kato
  • Tomoyuki Endo
  • Naoya Sakamoto
Case Report


Endoscopic sphincterotomy (ES) is a standard procedure for bile duct stone removal. However, the safety of ES in patients with hemophilia remains unknown. We treated a 46-year-old man who had choledocholithiasis and severe hemophilia A with high-responding inhibitors during immune tolerance induction therapy. Since coagulation factor VIII inhibitors neutralize and inactivate endogenous and exogenous factor VIII, bleeding risk is higher in hemophilia A patients with inhibitors than in those without inhibitors. With adequate pre- and post-procedure monitoring of the clotting factor and supplemented clotting factor, the patient could safely undergo ES without bleeding complications. ES can be also an effective and safe first-line therapy for choledocholithiasis in patients with hemophilia and inhibitors under the condition of appropriate management.


Endoscopic sphincterotomy Hemophilia Choledocholithiasis 


Compliance with ethical standards

Conflict of interest

Drs. Sugiura, Kuwatani, Kawakubo, Sano, Kato, Endo and Sakamoto declare that they have no conflict of interest.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient for being included in the study.


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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyHokkaido University Faculty of Medicine and Graduate School of MedicineSapporoJapan
  2. 2.Division of EndoscopyHokkaido University HospitalSapporoJapan
  3. 3.Department of HematologyHokkaido University Graduate School of MedicineSapporoJapan

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