Incidence, Predictors, and Outcomes of Clinically Significant Post-Endoscopic Retrograde Cholangiopancreatography Bleeding: A Contemporary Multicenter Study.

IF 8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI:10.14309/ajg.0000000000002946

Kirles Bishay, Yibing Ruan, Alan N Barkun, Yen-I Chen, Andrew Singh, Lawrence Hookey, Naveen Arya, Natalia Causada Calo, Samir C Grover, Peter D Siersema, Nirav Thosani, Saeed Darvish-Kazem, Deborah Siegal, Sydney Bass, Martin Cole, Yang Lei, Suqing Li, Rachid Mohamed, Christian Turbide, Millie Chau, Megan Howarth, Shane Cartwright, Hannah F Koury, Tamim Nashad, Zhao Wu Meng, Alejandra Tepox-Padrón, Ahmed Kayal, Emmanuel González-Moreno, Darren R Brenner, Zachary L Smith, Rajesh N Keswani, B Joseph Elmunzer, Sachin Wani, Ronald J Bridges, Robert J Hilsden, Steven J Heitman, Nauzer Forbes

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引用次数: 0

Abstract

Introduction: Clinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding (CSPEB) is common. Contemporary estimates of risk are lacking. We aimed to identify risk factors of and outcomes after CSPEB.

Methods: We analyzed multicenter prospective ERCP data between 2018 and 2024 with 30-day follow-up. The primary outcome was CSPEB, defined as hematemesis, melena, or hematochezia resulting in (i) hemoglobin drop ≥ 20 g/L or transfusion and/or (ii) endoscopy to evaluate suspected bleeding and/or (iii) unplanned healthcare visitation and/or prolongation of existing admission. Firth logistic regression was used. P values <0.05 were significant, with odds ratios (ORs) and 95% confidence intervals reported.

Results: CSPEB occurred after 129 (1.5%) of 8,517 ERCPs (mean onset 3.2 days), with 110 of 4,849 events (2.3%) occurring after higher risk interventions (sphincterotomy, sphincteroplasty, precut sphincterotomy, and/or needle-knife access). Patients with CSPEB required endoscopy and transfusion in 86.0% and 53.5% of cases, respectively, with 3 cases (2.3%) being fatal. P2Y 12 inhibitors were held for a median of 4 days (interquartile range 4) before higher risk ERCP. After higher risk interventions, P2Y 12 inhibitors (OR 3.33, 1.26-7.74), warfarin (OR 8.54, 3.32-19.81), dabigatran (OR 13.40, 2.06-59.96), rivaroxaban (OR 7.42, 3.43-15.24), and apixaban (OR 4.16, 1.99-8.20) were associated with CSPEB. Significant intraprocedural bleeding after sphincterotomy (OR 2.32, 1.06-4.60), but not after sphincteroplasty, was also associated. Concomitant cardiorespiratory events occurred more frequently within 30 days after CSPEB (OR 12.71, 4.75-32.54).

Discussion: Risks of antiplatelet-related CSPEB may be underestimated by endoscopists based on observations of suboptimal holding before higher risk ERCP. Appropriate periprocedural antithrombotic management is essential and could represent novel quality initiative targets.

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内镜逆行胰胆管造影术后临床重大出血的发生率、预测因素和结果：一项当代多中心研究。

导言：内镜逆行胰胆管造影术（ERCP）后出血（CSPEB）在临床上很常见。目前尚缺乏对其风险的估计。我们旨在确定 CSPEB 的风险因素和术后结果：我们分析了 2018 年至 2024 年 30 天随访的多中心前瞻性 ERCP 数据。主要结局为 CSPEB，定义为吐血、血便或血崩，导致（i）血红蛋白下降≥20 g/L 或输血和/或（ii）内镜检查以评估疑似出血和/或（iii）计划外就医和/或延长现有入院时间。采用费氏逻辑回归法。P 值结果：在 8,517 例 ERCP 中，有 129 例（1.5%）（平均发病时间为 3.2 天）发生了 CSPEB，在 4,849 例中，有 110 例（2.3%）发生在较高风险的介入治疗（括约肌切开术、括约肌成形术、预切开括约肌切开术和/或针刀入路）之后。86.0%和53.5%的CSPEB患者需要进行内镜检查和输血，其中3例（2.3%）患者死亡。在高风险ERCP前，P2Y 12抑制剂的中位数为4天（四分位数间距为4）。在高风险介入治疗后，P2Y 12 抑制剂（OR 3.33，1.26-7.74）、华法林（OR 8.54，3.32-19.81）、达比加群（OR 13.40，2.06-59.96）、利伐沙班（OR 7.42，3.43-15.24）和阿哌沙班（OR 4.16，1.99-8.20）与 CSPEB 相关。括约肌切开术（OR 2.32，1.06-4.60）后的严重术中出血也与 CSPEB 有关，但括约肌成形术后的出血与 CSPEB 无关。CSPEB术后30天内并发心肺事件的发生率更高（OR 12.71，4.75-32.54）：讨论：内镜医师可能会低估与抗血小板相关的 CSPEB 风险，因为他们观察到高风险 ERCP 术前的抗血小板治疗效果不佳。适当的围手术期抗血栓管理至关重要，可作为新的质量倡议目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

11.40

自引率

5.10%

发文量

458

审稿时长

12 months

期刊介绍： Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.