Endoscopic sphincterotomy-induced hemorrhage: a study of risk factors and the role of epinephrine injection.

BACKGROUND

We studied the incidence and relative risk factors for postsphincterotomy bleeding and the efficacy of epinephrine injection in hemostasis.

METHODS

We retrospectively analyzed the incidence of postsphincterotomy bleeding in 983 consecutive patients with sphincterotomy for common duct stones and risk factors for such bleeding, i.e., presence of coagulopathy, stone impaction, periampullary diverticulum, extension of previous sphincterotomy, and use of needle knife precut sphincterotomy in sphincterotomy-induced bleeding. Epinephrine irrigation was performed for mild bleeding, and injection with 1:10,000 epinephrine was performed to control more severe bleeding.

RESULTS

119 patients (12.1%) developed postsphincterotomy bleeding; 114 patients had immediate bleeding and 5 had delayed hemorrhage. Stone impaction at the papilla, periampullary diverticulum, and extension of a previous sphincterotomy were independent variables that increased the risk of bleeding. Forty-six percent of 119 patients with mild bleeding responded to epinephrine irrigation. The remaining required injection therapy with 1:10,000 epinephrine. Initial hemostasis was achieved in all. Rebleeding occurred in 5 patients but all responded to conservative management. None required emergency surgery and there was no mortality related to uncontrolled hemorrhage.

CONCLUSION

Epinephrine injection is a safe treatment for sphincterotomy-induced bleeding.