Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placementfor post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-sideincision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additionalendoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellenthemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimatetreatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should becarefully examined for bleeding points, even after the CSEMS placement.
Abstract
We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placementfor post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-sideincision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additionalendoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellenthemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimatetreatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should becarefully examined for bleeding points, even after the CSEMS placement.
참고문헌 (10)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
- Loperfido S, "Major early complications from diagnostic and therapeutic ERCP : a prospective multicenter study", Gastrointest Endosc, 48, pp.1~10 (1998)
- Masci E, "Complications of diagnostic and therapeutic ERCP : a prospective multicenter study", Am J Gastroenterol, 96, pp.417~423 (2001)
- ASGE Standards of Practice Committee, "Adverse events associated with ERCP", Gastrointest Endosc, 85, pp.32~47 (2017)
- Itoi T, "Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding", Endoscopy, 43, pp.369~372 (2011)
- Canena J, "Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations", Surg Endosc, 27, pp.313~324 (2013)
- Cochrane J, "Comparing endoscopic intervention against fully covered self-expanding metal stent placement for post-endoscopic sphincterotomy bleed(CEASE Study)", Endosc Int Open, 4, pp.E1261~E1264 (2016)
- Inoue T, "Early covered self-expandable metal stent placement is effective for massive post-endoscopic sphincterotomy bleeding", Dig Dis Sci, 65, pp.3324~3331 (2020)
- Cotton PB, "A lexicon for endoscopic adverse events : report of an ASGE workshop", Gastrointest Endosc, 71, pp.446~454 (2010)
- Iwasaki E, "Metal stent for refractory post-ES bleeding : is this the ultimate treatment modality?", Endosc Int Open, 4, pp.E1265~E1266 (2016)