MANAGEMENT OF CLINICALLY RELEVANT BLEEDING FOLLOWING ENDOSCOPIC SPHINCTEROTOMY

We report here on our experience of clinically relevant bleeding after endoscopic sphincterotomy (ES). Relevant bleeding was defined by the occurrence of (a) hematemesis or melena and (b) at least a two-point d rop in hemoglobin, with no other bleeding source on endoscopy. These t wo criteria were met in 16 patients between 1983 and 1992. They repres ented 0.65 % of all ES procedures performed during this period. Bleedi ng occurred immediately after ES in five cases, and was delayed in 11 cases from one to eight days (mean two days). Patients were retrospect ively classified into three groups according to the severity of bleedi ng and subsequent clinical management. In six cases (group 1), bleedin g developed slowly without shock and stopped spontaneously. In five ca ses (group 2), bleeding developed rapidly with melena and a drop in he moglobin, but without shock. These patients were successfully managed with sclerotherapy without any further complications. The five patient s in Group 3 had brisk bleeding with hematemesis and shock. Endoscopic hemostasis could not be performed; emergency arteriography disclosed active bleeding in four patients, and embolization of the gastroduoden al artery was performed. Bleeding stopped in all patients. Billroth II anastomosis appeared to be the only factor associated with an increas ed risk of clinically relevant bleeding. It was possible to control bl eeding following ES using endoscopic or angiographic hemostasis, surge ry being avoided in all cases.