Analysis On The Multiple Factors Of The Post-hemorrhage Endoscopic Sphincterotomy

Objective:To study the multiple factors of the post-hemorrhage endoscopic sphincterotomy.Method:Analyse and study the 1285 patients who underwent endoscopic retrograde cholangiopancreatography during August 2009 to August 2017 in the Shaanxi Provincial Peo Ple's Hospital,and among them,60 patients had post-hemorrhage endoscopic sphincterotomy,while 120 cases with no bleeding were selected as the control group(the age and sex of 1:2 were matched with the bleeding group).The retrospective cohort study was used to analyze the data by SPSS 17 software,through univariate data analysis and conditional logistic regression analysis to select several factors related to EST hemorrhage.Result:1.In the 1285 patients,bleeding occurred in 60 of EST patients,with the incidence is4.7%.Among them,mild bleeding occurred in 50 cases(83.3%),moderate bleeding in 7cases(11.7%),and severe bleeding in 3 cases(5%).52 patients were treated by injection of epinephrine and local electrocoagulation at the bleeding point;5 cases were used titanium metal clips to occlude artery;3 patients occurred severe intractable bleeding,failed to stop bleeding under the microscope,finally stopped bleeding by vascular intervention and embolization;No cases experience emergency surgery and death.2.By univariate data analysis,we reach that choledocholithiasis(?2=7.861,P<0.05),periampullary diverticula(?2=6.559,P<0.05),pre-cut sphincter(?2=8.082,P<0.05),long-incision of sphincter(?2=23.965,P<0.05),balloon catheter stone extraction(?2=19.600,P<0.05)and ENBD(?2= 4.726,P<0.05)associated with the EST hemorrhage.And the conditional logistic regression analysis indicates that,periampullary diverticula(?2=4.479,OR=4.479,P=0.034)?long-incision of sphincter(?2=5.004,OR=5.004,P=0.025)?balloon catheter stone extraction(?2=4.385,OR=4.385,P=0.036)are the independent risk factors of EST hemorrhage.3.In the 60 EST hemorrhage patients,39 cases are immediate hemorrhages,while 21 cases delayed hemorrhages,including 13 cases who had immediate bleeding,by endoscopic hemostasis successfully but appeared hemorrhage again after 24 hours.Also through single factor and multivariate statistical analysis,we can gain that intraoperative bleeding(?2=11.571,P<0.05)?periampullary diverticula(?2=4.432,P<0.05),pre-cut sphincter(?2=4.143,P<0.05),long-incision of sphincter(?2=4.846,P<0.05)are related to the delayed hemorrhage,and intraoperative bleeding(?2= 4.323,OR=5.824,P=0.038)is the independent risk factor for post-EST hemorrhage.Conclusions:1?Choledocholithiasis?periampullary diverticula?pre-cut sphincter?long-incision of sphincter?balloon catheter stone extraction and ENBD may increase the risk of EST hemorrhage.2?Periampullary diverticula?long-incision of sphincter and balloon catheter stone extraction are the independent risk factors associated with EST hemorrhage.3?Intraoperative bleeding?periampullary diverticula?pre-cut sphincter?long-incision of sphincter also may increase the risk of EST postoperative delayed hemorrhages.4?Intraoperative bleeding is the independent risk factor for delayed bleeding after EST.5?The patients with EST hemorrhage are common in mild bleeding(83.3%)and immediate bleeding(65%),and endoscopic injecting medicine?electrocoagulation and using titanium metal clips to get hemostasis are safe and effective,the success rate also is higher(95%).