TY - JOUR
T1 - Incidence, Predictors, and Outcomes of Clinically Significant Post-Endoscopic Retrograde Cholangiopancreatography Bleeding
T2 - A Contemporary Multicenter Study
AU - Kirles, Bishay
AU - Ruan, Yibing
AU - Barkun, Alan N.
AU - Chen, Yen I.
AU - Singh, Andrew
AU - Hookey, Lawrence
AU - Arya, Naveen
AU - Calo, Natalia Causada
AU - Grover, Samir C.
AU - Siersema, Peter D.
AU - Thosani, Nirav
AU - Darvish-Kazem, Saeed
AU - Siegal, Deborah
AU - Bass, Sydney
AU - Cole, Martin
AU - Lei, Yang
AU - Li, Suqing
AU - Mohamed, Rachid
AU - Turbide, Christian
AU - Chau, Millie
AU - Howarth, Megan
AU - Cartwright, Shane
AU - Koury, Hannah F.
AU - Nashad, Tamim
AU - Wu Meng, Zhao
AU - Tepox-Padrón, Alejandra
AU - Kayal, Ahmed
AU - González-Moreno, Emmanuel
AU - Brenner, Darren R.
AU - Smith, Zachary L.
AU - Keswani, Rajesh N.
AU - Elmunzer, B. Joseph
AU - Wani, Sachin
AU - Bridges, Ronald J.
AU - Hilsden, Robert J.
AU - Heitman, Steven J.
AU - Forbes, Nauzer
N1 - Publisher Copyright:
© 2024 by The American College of Gastroenterology.
PY - 2024/11/1
Y1 - 2024/11/1
N2 - 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. P2Y12 inhibitors were held for a median of 4 days (interquartile range 4) before higher risk ERCP. After 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 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.
AB - 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. P2Y12 inhibitors were held for a median of 4 days (interquartile range 4) before higher risk ERCP. After 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 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.
KW - ERCP
KW - adverse event
KW - bleeding
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85200219086&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85200219086&partnerID=8YFLogxK
U2 - 10.14309/ajg.0000000000002946
DO - 10.14309/ajg.0000000000002946
M3 - Article
C2 - 38976522
AN - SCOPUS:85200219086
SN - 0002-9270
VL - 119
SP - 2317
EP - 2325
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 11
ER -