Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a complex and challenging procedure with impressive diagnostic and therapeutic potential that comes along with a relatively low but real risk of adverse events. One of the more common adverse events is bleeding, typically from endoscopic sphincterotomy. Herein, we describe approaches for the practicing endoscopist to identify, prevent, and manage ERCP-related bleeding. Clinical judgment and knowledge of patient-related risk factors are important for preprocedure planning. Various techniques can be employed to mitigate bleeding risk during and after the procedure. Finally, we offer practical advice on managing these difficult cases when ERCP-related bleeding occurs.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Rustagi T, Jamidar PA. Endoscopic retrograde cholangiopancreatography-related adverse events. General overview. Gastrointest Endosc Clin N Am. 2015;25:97–106.
Freeman ML, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–19.
Chavalitdhamrong D, Donepudi S, Pu L, Draganov PV. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc. 2014;26:15–22.
Chandrasekhara V, et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85:32–47.
Cotton PB, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–93.
Cotton PB, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–54.
Sandblom P. Hemorrhage into the biliary tract following trauma; traumatic hemobilia. Surgery. 1948;24:571–86.
Katsinelos P, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol. 2014;27:65–72.
Adike A, Al-qaisi M, Baffy NJ, Kosiorek H, Pannala R. International normalized ratio does not predict gastrointestinal bleeding after endoscopic retrograde cholangiopancreatography in patients with cirrhosis. N Engl J Med. 2017;10:177–81.
Paik WH, et al. Optimal time of resuming anticoagulant after endoscopic sphincterotomy in patients at risk for thromboembolism: a retrospective cohort study. Surg Endosc. 32(9):3902–8.
Acosta RD, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3–16.
Keswani RN, Qumseya BJ, O’Dwyer LC, Wani S. Association between endoscopist and center endoscopic retrograde cholangiopancreatography volume with procedure success and adverse outcomes: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15:1866–1875.e3.
Wilcox CM, Canakis J, Mönkemüller KE, Bondora AW, Geels W. Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection. Am J Gastroenterol. 2004;99:244–8.
Tsou YK, et al. Treating delayed endoscopic sphincterotomy-induced bleeding: epinephrine injection with or without thermotherapy. World J Gastroenterol. 2009;15:4823–8.
Hwang JH, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012;75:1132–8.
Abdel Samie A. Fully covered self-expandable metal stents for treatment of malignant and benign biliary strictures. World J Gastrointest Endosc. 2012;4:405.
Shah JN, Marson F, Binmoeller KF. Temporary self-expandable metal stent placement for treatment of post-sphincterotomy bleeding. Gastrointest Endosc. 2010;72:1274–8.
Canena J, Liberato M, Horta D, Romão C, Coutinho A. Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations. Surg Endosc Other Interv Tech. 2013;27:313–24.
Itoi T, et al. Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding. Endoscopy. 2011;43:369–72.
Cochrane J, Schlepp G. Comparing endoscopic intervention against fully covered self-expanding metal stent placement for post-endoscopic sphincterotomy bleed (CEASE Study). Endosc Int Open. 2016;04:E1261–4.
Leung JWC, Chan FKL, Sung JJY, Chung SCS. Endoscopic sphincterotomy-induced hemorrhage: a study of risk factors and the role of epinephrine injection. Gastrointest Endosc. 1995;42:550–4.
Lee MH, et al. Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding. World J Gastroenterol. 2016;22:3196–201.
Adler DG, Lieb JG 2nd, Cohen J, et al. Quality Indicators for ERCP. Gastrointest Endosc. 2015;81(1):54–66.
Disclosures
SW is a consultant for Boston Scientific and Medtronic.
Funding
This study was supported by a grant from the University of Colorado, Department of Medicine, Outstanding Early Scholars Program (SW) and the NIH Gastrointestinal Diseases Training Grant T32 DK007038 (JK).
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kolb, J.M., Wani, S. (2019). ERCP-Related Bleeding Adverse Events. In: Mullady, D. (eds) Dilemmas in ERCP. Springer, Cham. https://doi.org/10.1007/978-3-030-12741-1_16
Download citation
DOI: https://doi.org/10.1007/978-3-030-12741-1_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-12740-4
Online ISBN: 978-3-030-12741-1
eBook Packages: MedicineMedicine (R0)