GASTROENTEROLOGY ARTICLE OF THE WEEK
February 7, 2008
Ferreira LE, Baron TH. Post-sphincterotomy bleeding: Who, What, When and How. Am J Gastroenterol 2007;102:2850-2858
1. Which of the following factors probably contribute to the risk of post-sphincterotomy bleeding?
a. Patient’s age
b. Use of NSAID’s or aspirin
c. Presence of cirrhosis
d. Cholangitis
e. Extension of prior sphincterotomy
f. Lower endoscopist case volume
g. Precut sphincterotomy
h. Cutting-only current compared to blended
True or False
2. The risk of major hemorrhage after ES is 10% to 15% if anticoagulation is reintroduced within 3 days of ES.
3. The incidence of post sphincterotomy bleeding, early or delayed is generally <3%
4. In contrast to PUD hemostasis, monotherapy with diluted epinephrine injection alone may be sufficient to control post ES bleeding.
5. Balloon sphincteroplasty carries a lower bleeding risk than sphincterotomy
6. A repeat ERCP in a patient with delayed post ES bleeding showing a black spot only at the sphincterotomy site requires additional thermal therapy to prevent rebleed
7. A platelet count of > 50,000 and INR < 1.5 are considered adequate for sphincterotomy
8. Most episodes of immediate post ES bleeding become clinically significant and aggressive early intervention is mandatory
9. Endoclips are more likely to fail if used through an ERCP endoscope