Is insertion of a plastic stent better and safer than epinephrine injection in post sphincterotomy bleeding?
| Autor: | Claus Mees, Niels Weller, Matthias Doll, Christel Weiß, Dorothea Schmidt, Peter Prinz, Stephan Werle, Daniel Schmitz, Andreas Günther, Barbara John, Jochen Rudi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Epinephrine Bilirubin Injections Prosthesis Implantation 03 medical and health sciences chemistry.chemical_compound Sphincterotomy Endoscopic 0302 clinical medicine medicine Humans Vasoconstrictor Agents Plastic stent Myocardial infarction Risk factor Adverse effect Aged Retrospective Studies Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Hepatology business.industry Gastroenterology Retrospective cohort study Middle Aged medicine.disease Treatment Outcome chemistry 030220 oncology & carcinogenesis Anesthesia Pancreatitis 030211 gastroenterology & hepatology Female Stents business Gastrointestinal Hemorrhage Plastics medicine.drug |
| Zdroj: | European journal of gastroenterologyhepatology. 32(4) |
| ISSN: | 1473-5687 |
| Popis: | Objectives Epinephrine injection is the therapy of first choice in post sphincterotomy bleeding (PSB), but may not be efficient in all cases and can cause postprocedural myocardial infarction. Plastic stent insertion (PSI) may be a better treatment. The aim of this retrospective study was to compare epinephrine injection with PSI with respect to efficacy and safety. Methods Clinical success, number of reinterventions and hospital stays after therapy, postprocedural myocardial infarction, bilirubin increase, and pancreatitis as well as factors influencing PSB were analyzed. Results Seventy-nine PSBs in 5798 endoscopic retrograde cholangiopancreaticographies (ERCPs) from August 2002 through October 2018 were treated by epinephrine injection, PSI or both (n = 34, 30, 15). Clinical success of PSB therapy showed no difference: 33/34 (97%), 30/30 (100%), 14/15 (93%). Reinterventions were more frequent (n = 30 versus n = 1; P ≤ 0.0001) and hospital stay was longer [median: 3 (2-10) versus 2 (1-3) days; P = 0.0357] in patients who received PSI (versus epinephrine injection). Postprocedural adverse events were very rare: bilirubin increase (1/2/0) and pancreatitis (0/2/1). Intraprocedural episodes of hypertension (≥180 mmHg) were documented in 45-54%. Conclusions Epinephrine injection is better than PSI in PSB. PSI may be an adequate treatment in patients with otherwise indicated stent insertion. Intraprocedural episodes of hypertension may be a risk factor for PSB. |
| Databáze: | OpenAIRE |
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