Background and study aims: Severe bleeding is a potentially lethal complication after endoscopic sphincterotomy
(EST) and endoscopic papillary balloon dilation (EPBD) for choledocholithiasis. This
study aimed to evaluate the impact of antiplatelet agents and anticoagulants on this
complication.
Patients and methods: Patients who underwent EST and EPBD were identified in a Japanese nationwide administrative
database covering 1090 hospitals. Adjusting for other potential risk factors, we evaluated
the association between oral administration of antiplatelet agents and/or anticoagulants
(continuation, discontinuation, and non-use) and clinically significant bleeding within
3 days of the procedure.
Results: In total, 61 002 patients were analyzed (EST, 54 493 patients; EPBD, 6509). The rate
of severe bleeding was 0.8 % in both groups, but EPBD was performed more frequently
than EST in patients with chronic renal failure, liver cirrhosis, and in those receiving
antiplatelet agents or anticoagulants. The impact of continuation/discontinuation
of antiplatelet agents on severe bleeding was not statistically significant in the
EST or EPBD groups. The use of anticoagulants was associated with a statistically
significant increase in severe bleeding compared with non-use for EST (1.6 % 27 of
1688 patients vs. 0.8 % 429 of 52 805 patients; adjusted odds ratio [OR] 1.70; 95 %
confidence interval [CI] 1.10 – 2.63) and for EPBD (3.0 % [8 of 263 patients] vs. 0.7 % 46 of 6246 patients; adjusted OR 2.91; 95 %CI 1.36 – 6.24).
Conclusions: EST and EPBD can be safely performed in patients receiving antiplatelet agents. Users
of anticoagulants are at high risk of bleeding, and the periprocedural management
of these should be further investigated.
