Abnormal clotting parameters before therapeutic ERCP: do they predict major bleeding?

A total of 399 consecutive patients undergoing 598 ERCPs (endoscopic retrog rade cholangiopancreatographies), including 88 pre-cut papillotomies and 20 6 conventional papillotomies, are described in a retrospective study, Clott ing parameters, haemoglobin levels, indications for pre-cut and/or conventi onal papillotomy and the use of drugs assumed to interfere with blood clott ing (anticoagulants, platelet-aggregation inhibitors, low-molecular-weight heparin) were evaluated in order to detect risk factors for ERCP-associated bleeding. The overall incidence of ERCP-associated bleeding was 18/598 (3. 0%), The incidence of bleeding in the group without papillotomy was 7/346 ( 2.0%), This group consisted of patients who underwent only a diagnostic ERC P, patients who had undergone papillotomy previously, patients in whom a re newed attempt was made to extract biliary stones, and patients in whom remo val or change of a stent was necessary. The incidence of papillotomy-associ ated bleeding was 11/252 (4.4%). Pre-cut papillotomy did and conventional p apillotomy did not significantly increase the incidence of bleeding: 15.2% (P< 0.001) and 1.9% (P = 1,00) respectively. The incidence of ERCP-associat ed bleeding in the group not using any drugs interfering with blood clottin g was 2,5%, The use of low-molecular-weight heparin (10.3%) during ERCP sig nificantly increased the risk of bleeding (P = 0,01). However, the use of p latelet aggregation inhibitors (2.4%) did not (P = 1.00). As the incidence of bleeding in patients with normal clotting parameters, including the pati ents with abnormal parameters which were well corrected (4.3%), was higher than in patients with abnormal haemostatic screens (2,7%), abnormal coagula tion tests did not predict ERCP-associated bleeding. Eur J Gastroenterol He patol 11:1093-1097 (C) 1999 Lippincott Williams & Wilkins.