Abstract
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.
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Drs. Sugiura, Kuwatani, Kawakubo, Sano, Kato, Endo and Sakamoto declare that they have no conflict of interest.
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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Sugiura, R., Kuwatani, M., Kawakubo, K. et al. Successful endoscopic sphincterotomy for choledocholithiasis in a patient with severe hemophilia A and inhibitors. Clin J Gastroenterol 11, 188–192 (2018). https://doi.org/10.1007/s12328-018-0826-8
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DOI: https://doi.org/10.1007/s12328-018-0826-8