Katsinelos Panagiotis, Lazaraki Georgia, Anastasiadis Sotiris, Chatzimavroudis Grigoris, Katsinelos Taxiarchis, Terzoudis Sotiris, Gatopoulou Anthi, Doulberis Michael, Papaefthymiou Apostolis, Kountouras Jannis
Department of Endoscopy, G. Gennimatas General Hospital (Panagiotis Katsinelos, Grigoris Chatzimavroudis).
Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras).
Ann Gastroenterol. 2019 Nov-Dec;32(6):614-619. doi: 10.20524/aog.2019.0425. Epub 2019 Oct 8.
Observational studies have shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs). We retrospectively investigated the impact of SSRIs, alone or combined with aspirin (ASA) or nonsteroidal anti-inflammatory drugs (NSAIDs), on the incidence of post-endoscopic sphincterotomy (post-ES) bleeding.
A total of 3058 patients were included. Of these, 457 patients received SSRIs, alone or plus ASA or NSAIDs, until the day of ES (SSRIs group), while 2659 patients (non SSRIs group) had never been on SSRIs (n=1925), though some had been on ASA (n=613) or NSAIDS (n=121). Patient assessment included indication for endoscopic retrograde cholangiopancreatography (ERCP), comorbid diseases, detailed drug history before and after ES, procedural details, and risk factors for post-ES bleeding. Primary outcome was defined as the incidence, type and severity of post-ES bleeding.
There was no statistical difference in age, sex, indication for ERCP, comorbid diseases, technical characteristics or results of therapeutic ERCP between the 2 groups. The incidence of post-ES bleeding was 3.9% in the SSRIs group and 3% in the non SSRIs group, a difference not statistically significant (P=0.754). Likewise, there was no difference in type (P=0.145) or severity of bleeding (P=0.754) between the 2 groups. Multivariate analysis showed the precut technique as the only independent risk factor for post ES hemorrhage (odds ratio 2.56, 95% confidence interval 1.23-3.63; P=0.001).
This study found that SSRIs, alone or combined with ASA or NSAIDs, had no influence on the incidence or the severity of post-ES bleeding.
观察性研究表明，选择性5-羟色胺再摄取抑制剂（SSRI）使用者发生上消化道出血的风险增加。我们回顾性研究了SSRI单独使用或与阿司匹林（ASA）或非甾体抗炎药（NSAID）联合使用对内镜下括约肌切开术后（ES后）出血发生率的影响。
共纳入3058例患者。其中，457例患者在ES当天前单独或联合使用ASA或NSAID接受SSRI治疗（SSRI组），而2659例患者（非SSRI组）从未使用过SSRI（n = 1925），尽管有些人曾使用过ASA（n = 613）或NSAID（n = 121）。患者评估包括内镜逆行胰胆管造影（ERCP）的指征、合并疾病、ES前后的详细用药史、手术细节以及ES后出血的危险因素。主要结局定义为ES后出血的发生率、类型和严重程度。
两组患者在年龄、性别、ERCP指征、合并疾病、技术特征或治疗性ERCP结果方面无统计学差异。SSRI组ES后出血发生率为3.9%，非SSRI组为3%，差异无统计学意义（P = 0.754）。同样，两组在出血类型（P = 0.145）或严重程度（P = 0.754）方面也无差异。多变量分析显示，预切开技术是ES后出血的唯一独立危险因素（比值比2.56，95%置信区间1.23 - 3.63；P = 0.001）。
本研究发现，SSRI单独使用或与ASA或NSAID联合使用对ES后出血的发生率或严重程度均无影响。
