ENDOSCOPIC SPHINCTEROTOMY-INDUCED HEMORRHAGE - A STUDY OF RISK-FACTORS AND THE ROLE OF EPINEPHRINE INJECTION

Background: We studied the incidence and relative risk factors for pos tsphincterotomy bleeding and the efficacy of epinephrine injection in hemostasis. Methods: We retrospectively analyzed the incidence of post sphincterotomy bleeding in 983 consecutive patients with sphincterotom y for common duct stones and risk factors for such bleeding, i.e., pre sence of coagulopathy, stone impaction, periampullary diverticulum, ex tension of previous sphincterotomy, and use of needle knife precut sph incterotomy in sphincterotomy-induced bleeding. Epinephrine irrigation was performed for mild bleeding, and injection with 1:10,000 epinephr ine was performed to control more severe bleeding. Results: 119 patien ts (12.1%) developed postsphincterotomy bleeding; 114 patients had imm ediate bleeding and 5 had delayed hemorrhage. Stone impaction at the p apilla, periampullary diverticulum, and extension of a previous sphinc terotomy were independent variables that increased the risk of bleedin g. Forty-six percent of 119 patients with mild bleeding responded to e pinephrine irrigation. The remaining required injection therapy with 1 :10,000 epinephrine. Initial hemostasis was achieved in all. Rebleedin g occurred in 5 patients but all responded to conservative management. None required emergency surgery and there was no mortality related to uncontrolled hemorrhage. Conclusion: Epinephrine injection is a safe treatment for sphincterotomy-induced bleeding.