Nakaji So, Hirata Nobuto, Matsui Hiroki, Shiratori Toshiyasu, Kobayashi Masayoshi, Yoshimura Shigenobu, Kanda Keisuke, Kawamitsu Natsuki, Harasawa Hisato
Department of Gastroenterology, Kameda Medical Center, Kamogawa City, Japan.
Clinical Research Support Division, Kameda Institute for Health Science, Kameda College of Health Sciences, Kamogawa City, Japan.
Endosc Int Open. 2018 May;6(5):E568-E574. doi: 10.1055/a-0587-4470. Epub 2018 May 8.
Hemodialysis (HD) is considered one of the risk factors for post-endoscopic sphincterotomy (ES) bleeding. Therefore, we conducted a retrospective study to evaluate HD as a risk factor for post-ES bleeding in patients with choledocholithiasis.
We used the post-ES bleeding rate as the main outcome measure. To evaluate the influence of HD on the risk of post-ES bleeding, logistic regression and propensity score analyses were conducted. In addition, univariate analysis-based comparisons of various clinical parameters (as secondary outcome measures) were performed between the patients in the HD and non-HD groups that experienced post-ES bleeding.
A total of 1518 patients were enrolled. In the multivariate analysis, a platelet count of < 50,000, anticoagulant therapy, bleeding during ES, and HD were found to be significantly associated with post-ES bleeding (odds ratio [OR]: 35.30, 95 % confidence interval [CI]: 3.81 - 328.00; OR: 4.39, 95 % CI: 1.53 - 12.60; OR: 4.28, 95 % CI: 2.30 - 7.97; and OR: 13.30, 95 % CI: 5.78 - 30.80, respectively). Propensity score matching created 28 matched pairs. Propensity score analysis showed that the risk difference between the groups was 0.214 (95 % CI: 0.022 - 0.407). In a comparison between the patients in the HD and non-HD groups that suffered post-ES bleeding, it was found that the post-ES bleeding was significantly more severe in the HD group (p = 0.033), and massive blood transfusions and long periods of hospitalization were more frequently required in the HD group (p = 0.008 and p < 0.001, respectively).
HD is an independent risk factor for post-ES bleeding and makes post-ES bleeding more serious.
血液透析（HD）被认为是内镜下括约肌切开术（ES）后出血的危险因素之一。因此，我们进行了一项回顾性研究，以评估HD作为胆总管结石患者ES后出血的危险因素。
我们将ES后出血率作为主要结局指标。为评估HD对ES后出血风险的影响，进行了逻辑回归和倾向评分分析。此外，对发生ES后出血的HD组和非HD组患者的各种临床参数（作为次要结局指标）进行基于单因素分析的比较。
共纳入1518例患者。多因素分析发现，血小板计数<50,000、抗凝治疗、ES期间出血和HD与ES后出血显著相关（比值比[OR]：35.30，95%置信区间[CI]：3.81 - 328.00；OR：4.39，95% CI：1.53 - 12.60；OR：4.28，95% CI：2.30 - 7.97；以及OR：13.30，95% CI：5.78 - 30.80）。倾向评分匹配产生了28对匹配对。倾向评分分析显示，两组之间的风险差异为0.214（95% CI：0. 022 - 0.407）。在发生ES后出血的HD组和非HD组患者的比较中，发现HD组的ES后出血明显更严重（p = 0.033），HD组更频繁地需要大量输血和长时间住院（分别为p = 0.008和p < 0.001）。
HD是ES后出血的独立危险因素，并使ES后出血更严重。
