Bleeding after endoscopic intervention for the major duodenal papilla (a literature review)

Abstract

Endoscopic biliary sphincterotomy (EST) is the cornerstone of endoscopic retrograde cholangiopancreatography (ERCP), and bleeding is one of the most common complications after performing EST. The frequency of bleeding after EST varies greatly from 1.0 % to 48.0 %. Clinically, bleeding can range from minor to life-threatening. The aim of the work was to find out the frequency and risk factors for immediate, delayed and recurrent bleeding after EST, ways of prevention and the most effective methods of treatment for this complication based on the meta-analysis results of recent years. Conclusions. Bleeding after endoscopic papillosphincterotomy is a common complication with a mortality rate of 1.2–9.0 %. Independent risk factors are liver cirrhosis, duodenal ulcer, end-stage renal failure, hemodialysis, duration of the procedure, prior use of antiplatelet drugs, especially in patients with a low level of platelets (<100,000/μL), and elderly individuals (>80 years). The risk of bleeding after EST does not depend on the size of papillectomy, and the preventive use of proton pump inhibitors does not reduce the risk of bleeding after EST. The advantages of endoscopic papillary balloon dilatation in reducing the risk of bleeding in patients with liver cirrhosis and in individuals on hemodialysis have been proven. The use of stents (FC-SEMS) is recognized as an effective hemostatic approach to refractory bleeding after EST but is limited in using due to the high cost and additional stent removal procedure. Endoscopic application of peptide hemostatic gel is considered as a third-line hemostatic strategy for bleeding after performing EST.