Major bleeding risk of endoscopic sphincterotomy versus endoscopic papillary balloon dilatation in hemodialysis patients
Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of pati...
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| Published in | Saudi journal of gastroenterology Vol. 25; no. 2; pp. 106 - 112 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
India
Wolters Kluwer India Pvt. Ltd
01.03.2019
Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd Wolters Kluwer - Medknow Wolters Kluwer Medknow Publications |
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| Online Access | Get full text |
| ISSN | 1319-3767 1998-4049 1998-4049 |
| DOI | 10.4103/sjg.SJG_246_18 |
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| Abstract | Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD).
Patients and Methods: The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1st January 2004 and 31st December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients.
Results: A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484).
Conclusion: Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients. |
|---|---|
| AbstractList | Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD). Patients and Methods: The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1stJanuary 2004 and 31stDecember 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients. Results: A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484). Conclusion: Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients. Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD).BACKGROUND/AIMSEndoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD).The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1st January 2004 and 31st December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients.PATIENTS AND METHODSThe NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1st January 2004 and 31st December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients.A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484).RESULTSA total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484).Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients.CONCLUSIONPost-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients. Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD). The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1 January 2004 and 31 December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients. A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484). Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients. Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD). Patients and Methods: The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1st January 2004 and 31st December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients. Results: A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484). Conclusion: Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients. Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The postprocedure bleeding rate for EPBD is low in the normal population; however, this bleeding rate in a group of patients prone to bleeding, such as patients with end-stage renal disease, is not well-established. We therefore evaluated the post-EST and post-EPBD bleeding rate among hemodialysis (HD) patients based on data from Taiwan's National Health Insurance Research Database (NHIRD). Patients and Methods: The NHIRD entries for a population of 2 million were screened for patients who had a catastrophic illness card for HD between 1st January 2004 and 31st December 2011 and these patients were enrolled as research subjects. The rates of major gastrointestinal tract bleeding events appearing within 14 days after EST or EPBD were compared between HD and non-HD patients. Results: A total of 3561 patients, over 18 years of age and without liver cirrhosis or hematologic diseases, underwent 3826 EST and 280 EPBD procedures during the 8 calendar years selected for our analysis. The total post-ERCP major bleeding rate was much higher in HD than in non-HD patients (8.64% vs. 2.16%, P < 0.0001). The rate of postprocedure major bleeding events was lower for non-HD patients who underwent EPBD than those who underwent EST (0.75% vs. 2.26%; P = 0.049), whereas the postprocedure major bleeding event rates were similar in HD patients who underwent either EPBD or EST (8.70% vs. 8.33%; P = 0.484). Conclusion: Post-ERCP, post-EST, and post-EPBD major bleeding rates were all higher in HD patients in this study. EPBD resulted in lower postprocedure major bleeding events than EST in the non-HD population, but it failed to provide the reduction in bleeding events needed to perform endoscopic hemostasis in HD patients. |
| Audience | Academic |
| Author | Yang, Tzu-Wei Lin, Chun-Che Tsai, Ming-Chang Tseng, Ming-Hseng Chen, Hsuan-Yi Wang, Yao-Tung Wang, Chi-Chih |
| AuthorAffiliation | 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 4 Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 2 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 7 Information Technology Office, Chung Shan Medical University Hospital, Taichung, Taiwan 5 Department of Biological Science and Technology, Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan 6 Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan 1 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan |
| AuthorAffiliation_xml | – name: 1 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan – name: 6 Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan – name: 7 Information Technology Office, Chung Shan Medical University Hospital, Taichung, Taiwan – name: 5 Department of Biological Science and Technology, Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan – name: 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan – name: 2 School of Medicine, Chung Shan Medical University, Taichung, Taiwan – name: 4 Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan |
| Author_xml | – sequence: 1 givenname: Ming-Chang surname: Tsai fullname: Tsai, Ming-Chang organization: Institute of Medicine, Chung Shan Medical University; School of Medicine, Chung Shan Medical University; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung – sequence: 2 givenname: Chi-Chih surname: Wang fullname: Wang, Chi-Chih organization: Institute of Medicine, Chung Shan Medical University; School of Medicine, Chung Shan Medical University; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung – sequence: 3 givenname: Yao-Tung surname: Wang fullname: Wang, Yao-Tung organization: Institute of Medicine, Chung Shan Medical University; School of Medicine, Chung Shan Medical University; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung – sequence: 4 givenname: Tzu-Wei surname: Yang fullname: Yang, Tzu-Wei organization: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung; Department of Biological Science and Technology, Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu – sequence: 5 givenname: Hsuan-Yi surname: Chen fullname: Chen, Hsuan-Yi organization: School of Medicine, Chung Shan Medical University; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung – sequence: 6 givenname: Ming-Hseng surname: Tseng fullname: Tseng, Ming-Hseng organization: Department of Medical Informatics, Chung Shan Medical University; Information Technology Office, Chung Shan Medical University Hospital, Taichung – sequence: 7 givenname: Chun-Che surname: Lin fullname: Lin, Chun-Che organization: Institute of Medicine, Chung Shan Medical University; School of Medicine, Chung Shan Medical University; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2019 Medknow Publications and Media Pvt. Ltd. 2019. This work is published under https://creativecommons.org/licenses/by-nc-sa/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright: © 2018 Saudi Journal of Gastroenterology 2018 |
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| Keywords | hemodialysis Endoscopic papillary balloon dilatation postprocedure bleeding endoscopic sphincterotomy |
| Language | English |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Ming-Hseng Tseng and Chun-Che Lin contributed equally to this work |
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| References_xml | – start-page: 3196 volume-title: Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding year: 2016 ident: key-10.4103/1319-3767.246137-24 publication-title: World J Gastroenterol – start-page: 658 volume-title: Classification and management of perforations complicating endoscopic sphincterotomy year: 1999 ident: key-10.4103/1319-3767.246137-7 publication-title: Surgery – start-page: 80 volume-title: Risk factors for complications after ERCP: A multivariate analysis of 11,497 procedures over 12 years year: 2009 ident: key-10.4103/1319-3767.246137-18 publication-title: Gastrointest Endosc – start-page: 61 volume-title: Taiwan's new national health insurance program: Genesis and experience so far year: 2003 ident: key-10.4103/1319-3767.246137-14 publication-title: Health Aff (Millwood) – start-page: 417 volume-title: Complications of diagnostic and therapeutic ERCP: A prospective multicenter study year: 2001 ident: key-10.4103/1319-3767.246137-5 publication-title: Am J Gastroenterol – start-page: 752 volume-title: Endoscopic cannulation of the ampulla of vater: A preliminary report year: 1968 ident: key-10.4103/1319-3767.246137-1 publication-title: Ann Surg – start-page: 1165 volume-title: Histamine2-receptor antagonists are an alternative to proton pump inhibitor in patients receiving clopidogrel year: 2010 ident: key-10.4103/1319-3767.246137-16 publication-title: Gastroenterology – start-page: 127 volume-title: Complications of diagnostic and therapeutic ERCP year: 1999 ident: key-10.4103/1319-3767.246137-6 publication-title: Ann Chir Gynaecol – start-page: 202 volume-title: Therapeutic endoscopy in the 1990s: Objectivity, teaching, and service year: 1991 ident: key-10.4103/1319-3767.246137-17 publication-title: Gastrointest Endosc – start-page: 379 volume-title: Subcapsular hepatic hematoma after ERCP year: 2008 ident: key-10.4103/1319-3767.246137-22 publication-title: Gastrointest Endosc – start-page: 531 volume-title: Hemobilia in hereditary hemorrhagic telangiectasia: An unusual complication of endoscopic retrograde cholangiopancreatography year: 2003 ident: key-10.4103/1319-3767.246137-20 publication-title: Endoscopy – start-page: 127 volume-title: Endoscopic sphincterotomy in patients with liver cirrhosis year: 1996 ident: key-10.4103/1319-3767.246137-25 publication-title: Gastrointest Endosc – start-page: 909 volume-title: Complications of endoscopic biliary sphincterotomy year: 1996 ident: key-10.4103/1319-3767.246137-8 publication-title: N Engl J Med – start-page: 918 volume-title: Endoscopic papillary balloon dilation for bile duct stones in patients on hemodialysis year: 2012 ident: key-10.4103/1319-3767.246137-13 publication-title: J Gastroenterol – start-page: 1781 volume-title: Incidence rates of post-ERCP complications: A systematic survey of prospective studies year: 2007 ident: key-10.4103/1319-3767.246137-19 publication-title: Am J Gastroenterol – start-page: 643 volume-title: The role of endoscopy in the evaluation and treatment of patients with pancreaticobiliary malignancy year: 2003 ident: key-10.4103/1319-3767.246137-3 publication-title: Gastrointest Endosc – start-page: 180 volume-title: Endoscopic sphincterotomy vs.endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy year: 2004 ident: key-10.4103/1319-3767.246137-23 publication-title: Gastrointest Endosc – start-page: 353 volume-title: Efficacy and safety of therapeutic ERCP in patients with cirrhosis: A large multicenter study year: 2016 ident: key-10.4103/1319-3767.246137-26 publication-title: Gastrointest Endosc – start-page: 997 volume-title: Bleeding after endoscopic sphincterotomy or papillary balloon dilation among users of antithrombotic agents year: 2015 ident: key-10.4103/1319-3767.246137-12 publication-title: Endoscopy – start-page: 1641 volume-title: Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease year: 2009 ident: key-10.4103/1319-3767.246137-15 publication-title: Gastroenterology – start-page: 86 volume-title: Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video) year: 2016 ident: key-10.4103/1319-3767.246137-21 publication-title: Clin J Gastroenterol – start-page: 635 volume-title: Current management of postoperative complications and benign biliary strictures year: 2003 ident: key-10.4103/1319-3767.246137-4 publication-title: Gastrointest Endosc Clin N Am – start-page: 793 volume-title: Risk factors for complication following ERCP; 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| Snippet | Background/Aims: Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde... Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) are used for therapeutic endoscopic retrograde cholangiopancreatography... |
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| SubjectTerms | Adult Aged Aged, 80 and over Anticoagulants Blood diseases Cholangiopancreatography, Endoscopic Retrograde - standards Chronic kidney failure Dilatation - adverse effects Dilatation - instrumentation Endoscopic papillary balloon dilatation Endoscopic retrograde cholangiopancreatography endoscopic sphincterotomy Endoscopy Female Gastrointestinal Tract - blood supply Gastrointestinal Tract - pathology Health Hemodialysis Hemorrhage Hemorrhage - epidemiology Hemorrhage - etiology Hospitals Humans Illnesses Insurance Kidney diseases Kidney Failure, Chronic - therapy Liver cirrhosis Male Medical research Methods Middle Aged National health insurance Online databases Original Population Postoperative Hemorrhage - epidemiology postprocedure bleeding Renal Dialysis - adverse effects Renal Dialysis - statistics & numerical data Retrospective Studies Risk factors Software Sphincterotomy, Endoscopic - adverse effects Sphincterotomy, Endoscopic - methods Studies Taiwan - epidemiology |
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| Title | Major bleeding risk of endoscopic sphincterotomy versus endoscopic papillary balloon dilatation in hemodialysis patients |
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