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- Title
Major bleeding risk of endoscopic sphincterotomy versus endoscopic papillary balloon dilatation in hemodialysis patients.
- Authors
Tsai, Ming-Chang; Wang, Chi-Chih; Wang, Yao-Tung; Yang, Tzu-Wei; Chen, Hsuan-Yi; Tseng, Ming-Hseng; Lin, Chun-Che
- Abstract
Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD). Patients and Methods: The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1st January 2004 and 31st December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients. Results: A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484). Conclusion: Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients.
- Subjects
TAIWAN; SURGICAL complication risk factors; HEMORRHAGE risk factors; BLOOD diseases; CATASTROPHIC illness; CATHETERIZATION; ENDOSCOPIC retrograde cholangiopancreatography; GASTROINTESTINAL hemorrhage; HEMODIALYSIS patients; HEALTH insurance; CIRRHOSIS of the liver; MEDICAL screening; ENDOSCOPIC gastrointestinal surgery; SPHINCTERECTOMY
- Publication
Saudi Journal of Gastroenterology, 2019, Vol 25, Issue 2, p106
- ISSN
1319-3767
- Publication type
Article
- DOI
10.4103/sjg.SJG_246_18