Korean J Pancreas Biliary Tract.  2017 Jan;22(1):14-18. 10.15279/kpba.2017.22.1.14.

Post-Endoscopic Sphincterotomy Bleeding: Strategic Approach with Multiple Endoscopic Arms

Affiliations
  • 1Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea. joungho@cbnu.ac.kr

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.

Keyword

Endoscopic retrograde cholangiopancreatography; Endoscopic hemostasis; Endoscopic sphincterotomy

MeSH Terms

Arm*
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Diagnosis
Electrocoagulation
Endoscopes
Epinephrine
Fibrin Tissue Adhesive
Hemobilia
Hemodynamics
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic
Ligation
Methods
Peptic Ulcer
Shock
Sphincterotomy, Endoscopic
Epinephrine
Fibrin Tissue Adhesive
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