Endoscopic biliary sphincterotomy in patients under antithromboembolic therapy

Abstract

Abstract Background Endoscopic sphincterotomy (EST) carries several risks (e. g., pancreatitis and bleeding). The risk of bleeding is increased in patients with a compromised coagulation system, often due to antithromboembolic therapy. Recent guidelines caution to perform endoscopic procedures that carry a high risk of bleeding in these patients. However, data to support current recommendations are scarce, and EST frequently has to be performed as an emergency procedure. Therefore, it was the aim of our retrospective study to evaluate the rate of procedural bleeding in patients undergoing EST in our endoscopy unit while on antithromboembolic therapy. Methods Between March 2005 and August 2015, 1798 consecutive patients underwent EST at HELIOS Hospital in Pforzheim, Germany. Concomitant therapy with anticoagulants and/or antiplatelet agents was noted, and bleeding following sphincterotomy was recorded. Results We observed 54 bleeding events in 1482 patients (3.6 %) without and 20 events in 316 patients (6.3 %) with antithromboembolic therapy. Bleeding was recorded in 7 out of 123 patients (5.7 %) taking aspirin, in one out of 34 patients (2.9 %) taking clopidogrel, and in 12 out of 209 patients under heparin (5.7 %). Compared to controls, no statistically significant increase in the bleeding rate was seen. However, we observed an association between a lower physical health score and increased bleeding rate. If precut was necessary for biliary tract access, the bleeding rate increased significantly (p < 0.01). Conclusion Bleeding following EST is neither increased in patients taking clopidogrel and/or aspirin or heparin and rarely requires transfusion of packed red blood cells nor does it lead to an increased mortality. However, bleeding following EST seems to occur more frequently in patients with a compromised health status or following precut of the papilla.