Risk Factors, Prevention And Treatment Of Post-endoscopic Sphincterotomy Bleeding

Objective:This study was aim to define the incidence of post-endoscopic sphincterotomy bleeding(PESB),and study the risk factors by the Logistic regression analysis. Meanwhile we want to find out the Clinical characteristics and possible preventive measures to reduce the incidence of PESB.Method:A retrospective analysis was performed based on 8477 clinical cases which underwent ERCP and received EST in NO.1 affiliated hospital of Nanchang University from January 2007 to June 2015.137 cases developed PESB,choosing 548 patients from the rest cases by 1:4 draw as the control grop. The clinical data were investigated retrospectively, and risk factors for PESB were univariately and multivariately analyzed, than fing the effective treatment of PESB.Result:There are 8477 cases involved which underwent ERCP and received EST, 137cases(1.62%) developed PESB. In the univariate analysis, EST incision size, EST incision direction, bilirubin,immediately bleeding and pre-cut were statistically significant(P<0. 05), in the multiveariate analysis, EST incision direction departure(OR=2.184,95%CI=1.266,3.767).immediately bleeding(OR=3.326,95%CI=1.785,6.196)and pre-cut(OR= 2.310,95%CI=1.277.4.179)were the risk factors ofthe post-ERCP cholangitis.Among the 137 cases of PESB group, mild,moderate, severe bleeding are respectively 101 cases, 29 cases, 7 cases, hemostatic treatment of pure drug were 60 cases and all of the cases(are) in patients with mild bleeding, joint endoscopic and drugs treatment were 77 cases, all patients were successful hemostasis.Conclusion:There are many factors related to post-endoscopic sphincterotomy bleeding,EST incision direction departure, immediately bleeding and pre-cut are the risk factors ofthe PESB.Most post-endoscopic sphincterotomy bleeding were mild or moderate,Most need to endoscopic hemostatic.Hemostatic rate was 100%.In view of the associated risk factors, preoperative patients for adequate assessment, reasonable choice indications;control cut direction, reduce the risk of immediately bleeding, efforts to improve the success rate of intubation and reduce the rate of pre-cut, caused by the risk of PESB to a minimum.Endoscopic therapies efficient, if found that the PESB, we suggest use endoscopic therapies timely to treat bleeding.