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Incidence, Predictors, and Outcomes of Clinically Significant Post-ERCP Bleeding: a Contemporary Multi-center Study.
Bishay, Kirles; Ruan, Yibing; Barkun, Alan N; Chen, Yen-I; Singh, Andrew; Hookey, Lawrence; Arya, Naveen; Calo, Natalia Causada; Grover, Samir C; Siersema, Peter D; Thosani, Nirav; Darvish-Kazem, Saeed; Siegal, Deborah; Bass, Sydney; Cole, Martin; Lei, Yang; Li, Suqing; Mohamed, Rachid; Turbide, Christian; Chau, Millie; Howarth, Megan; Cartwright, Shane; Koury, Hannah F; Nashad, Tamim; Meng, Zhao Wu; Tepox-Padrón, Alejandra; Kayal, Ahmed; González-Moreno, Emmanuel; Brenner, Darren R; Smith, Zachary L; Keswani, Rajesh N; Elmunzer, B Joseph; Wani, Sachin; Bridges, Ronald J; Hilsden, Robert J; Heitman, Steven J; Forbes, Nauzer.
Affiliation
  • Bishay K; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
  • Ruan Y; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Barkun AN; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Chen YI; Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
  • Singh A; Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, QC, Canada.
  • Hookey L; Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, QC, Canada.
  • Arya N; Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of British Columbia, Victoria, BC, Canada.
  • Calo NC; Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, ON, Canada.
  • Grover SC; Division of Gastroenterology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada.
  • Siersema PD; Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
  • Thosani N; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
  • Darvish-Kazem S; Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
  • Siegal D; Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
  • Bass S; Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA.
  • Cole M; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Lei Y; Division of Hematology Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
  • Li S; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Mohamed R; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Turbide C; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Chau M; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Howarth M; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Cartwright S; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Koury HF; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Nashad T; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Meng ZW; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Tepox-Padrón A; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Kayal A; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • González-Moreno E; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Brenner DR; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
  • Smith ZL; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Keswani RN; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Elmunzer BJ; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Wani S; Department of Medicine, Faculty of Medicine - Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
  • Bridges RJ; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Hilsden RJ; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Heitman SJ; Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
  • Forbes N; Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
Am J Gastroenterol ; 2024 Jul 05.
Article in En | MEDLINE | ID: mdl-38976522
ABSTRACT
BACKGROUND

AIMS:

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

METHODS:

We analyzed multi-center prospective ERCP data between 2018-2023 with 30-day follow-up. The primary outcome was CSPEB, defined as hematemesis, melena, or hematochezia resulting in hemoglobin drop ≥20 g/L or transfusion and/or endoscopy to evaluate suspected bleeding, and/or unplanned healthcare visitation and/or prolongation of existing admission. Firth logistic regression was employed. P-values <0.05 were significant, with odds ratios (ORs) and 95% confidence intervals reported.

RESULTS:

CSPEB occurred following 129 (1.5%) of 8,517 ERCPs (mean onset 3.2 days), with 110 of 4,849 events (2.3%) occurring following higher-risk interventions (sphincterotomy, sphincteroplasty, pre-cut sphincterotomy, and/or needle-knife access). CSPEB patients required endoscopy and transfusion in 86.0% and 53.5% of cases, respectively, with three cases (2.3%) being fatal. P2Y12 inhibitors were held for a median of 4 days (IQR 4) prior to higher-risk ERCP. Following higher-risk interventions, P2Y12 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 post sphincterotomy (OR 2.32, 1.06-4.60), but not post sphincteroplasty, was also associated. Concomitant cardiorespiratory events occurred more frequently within 30 days following CSPEB (OR 12.71, 4.75-32.54).

CONCLUSIONS:

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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Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Am J Gastroenterol Year: 2024 Document type: Article
Fulltext
Print
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PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Am J Gastroenterol Year: 2024 Document type: Article