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- Title
Early Covered Self-Expandable Metal Stent Placement Is Effective for Massive Post-endoscopic Sphincterotomy Bleeding.
- Authors
Inoue, Tadahisa; Ibusuki, Mayu; Kitano, Rena; Kobayashi, Yuji; Ohashi, Tomohiko; Nakade, Yukiomi; Sumida, Yoshio; Ito, Kiyoaki; Yoneda, Masashi
- Abstract
Background: Placement of covered self-expandable metallic stent (CSEMS) for post-endoscopic sphincterotomy (ES) bleeding achieves excellent hemostasis results. Although CSEMS placement is typically performed after failure of conventional endoscopic combination therapy, its excellent outcomes may justify earlier placement. Aims: We aimed to examine the efficacy of "early" CSEMS placement for massive post-ES bleeding. Methods: The medical records of 2750 patients who underwent ES between 2005 and 2019 were reviewed retrospectively, and 61 patients who developed massive post-ES bleeding were enrolled. These patients were divided into those who underwent early CSEMS placement (E-CSEMS group) and those who underwent conventional endoscopic combination therapy (Conventional group). The outcomes of hemostasis procedures were compared between the groups. Results: The primary success rates of endoscopic hemostasis were 100% (21/21) and 98% (39/40) in the E-CSEMS group and Conventional group, respectively, without significant differences (P = 1.000). However, in the E-CSEMS group, re-bleeding was significantly less frequent (5% vs. 31%; P = 0.023), the median hemostasis procedure time was significantly shorter (14 min vs. 26 min; P < 0.001), and transfusion after initial hemostasis treatment was less commonly required (10% vs. 38%; P = 0.034). Multivariate analyses showed that hemodialysis was associated with a significantly higher re-bleeding rate (P = 0.029), while CSEMS placement was associated with a significantly lower re-bleeding rate (P = 0.039). Conclusions: Early CSEMS placement may be effective for improving the clinical outcomes of massive post-ES bleeding by decreasing re-bleeding and the extent of bleeding.
- Subjects
ENDOSCOPIC hemostasis; HEMORRHAGE; MEDICAL records; MULTIVARIATE analysis; METALS
- Publication
Digestive Diseases & Sciences, 2020, Vol 65, Issue 11, p3324
- ISSN
0163-2116
- Publication type
Article
- DOI
10.1007/s10620-020-06057-0