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MANAGEMENT OF ENDOSCOPIC SPHINCTEROTOMY‐INDUCED BLEEDING
Author(s) -
Ryozawa Shomei,
Urayama Naoki,
Iwano Hirotoshi,
Mikuriya Kuniko,
Sakaida Isao
Publication year - 2007
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2007.00722.x
Subject(s) - medicine , hemostasis , balloon tamponade , coagulopathy , surgery , epinephrine , tamponade , bleed , hemostatics , anesthesia
Bleeding is one of the most common and potentially serious complications of endoscopic sphincterotomy (ES) and the overall frequency ranges from 2% to 5%. Patients with coagulopathy and anticoagulant therapy should be excluded from ES. ES using microprocessor‐controlled electrosurgical generator setting for Endocut mode, and a step‐wise manner of controlled incision may reduce the frequency of bleeding. Once ES‐induced bleeding occurs, diluted epinephrine irrigation, coagulation using papillotome, and balloon tamponade may be effective. If the bleeding continues, vessel ligation with a hemoclip should be performed to achieve a permanent hemostasis. Diluted epinephrine injection is an alternative technique when the point of bleeding is not identified. All endoscopists who perform ES should have suitable knowledge of management of bleeding and be experts in hemostasis.