Endoscopy 2019; 51(04): S122
DOI: 10.1055/s-0039-1681530
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 14:30 – 16:00: ERCP cannulation 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

TREATMENT OF REFRACTORY POST-SPHINCTEROTOMY AND POST-PAPILLECTOMY BLEEDING BY ENDOSCOPIC FIBRIN GLUE INJECTION. RESULTS OF A LARGE SERIES

G Valerii
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
A Tringali
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
F Borrelli de Andreis
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
S Greco
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
V Perri
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
P Familiari
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
I Boškoski
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
,
G Costamagna
1   Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Digestive Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Bleeding is one of the most common complication after endoscopic biliary sphincterotomy (ES) and post-papillectomy. Endoscopic hemostasis can be achieved by epinephrine, hemoclip, thermal coagulation or combining these options. Transarterial embolization (TAE) or even surgery are the last options to control bleeding. Aim of this study is to evaluate the results and the long-term follow-up of treatment of refractory post-sphincterotomy and post-papillectomy bleeding with endoscopic injection of fibrin glue.

Methods:

Consecutive patients with refractory intraoperative or delayed bleeding following endoscopic sphincterotomy or papillectomy between October 2007 and February 2017 were identified from an electronic database. The following data were recorded: type of procedure with bleeding, treatment of first bleeding (diluted ephinephrine injection, hemoclips or thermal coagulation), time between first and last bleeding, complications. Fibrin glue (Tissucol, Baxter, frozen storage; Beriplast P, CSL Behring, refrigerator storage) was injected only for refractory bleeding.

Results:

Over a 9 years period and a case volume of > 10000 ERCPs, refractory post-sphincterotomy and post-papillectomy bleeding occurred in 63 cases, 26 intraoperative (40.6%) and 37 delayed (57.8%). All cases were treated with fibrin glue and stable hemostasis was reached in 61 (95.3%) cases except in 2 cases and in one case also after fully covered metal stent insertion, emergency arteriography diagnosed, and successfully treated in one case gastroduodenal artery pseudoaneurism, surgery was necessary in the other one. After fibrin glue injection 29 patients received a biliary stent, 32 a NBD, 2 patients both. Cholangiography through the NBD showed an intraductal fibrin clot in 2 cases (6.3%) easily removed with a Dormia basket. No cases of pancreatitis were reported after fibrin glue injection.

Conclusions:

Endoscopic fibrin glue injection for refractory post-sphincterotomy and post-papillectomy bleeding could represent a safe and effective treatment. Main limitation of this series is the lack of a control group.