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Yoshida M, Inoue T, Naitoh I, et al. Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding. Clin Endosc. 2020;doi: 10.5946/ce.2020.217.
Yoshida, M., Inoue, T., Naitoh, I., Hayashi, K., Hori, Y., Natsume, M., Atsuta, N., & Kataoka, H. (2020). Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding. Clinical endoscopy, . https://doi.org/10.5946/ce.2020.217
Yoshida, Michihiro, et al. "Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding." Clinical endoscopy vol. (2020). doi: https://doi.org/10.5946/ce.2020.217
Yoshida M, Inoue T, Naitoh I, Hayashi K, Hori Y, Natsume M, Atsuta N, Kataoka H. Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding. Clin Endosc. 2020 Nov 19; doi: 10.5946/ce.2020.217. Epub 2020 Nov 19. PMID: 33207403.
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Clin Endosc. 2020 Nov 19; doi: 10.5946/ce.2020.217. Epub 2020 Nov 19.

Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding.

Clinical endoscopy

Michihiro Yoshida, Tadahisa Inoue, Itaru Naitoh, Kazuki Hayashi, Yasuki Hori, Makoto Natsume, Naoki Atsuta, Hiromi Kataoka

Affiliations

  1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
  2. Department of Gastroenterology, Aichi Medical University, Nagakute, Japan.

PMID: 33207403 DOI: 10.5946/ce.2020.217

Abstract

We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placement for post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1 patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement 1-5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-side incision lines (3 or 9 o'clock) had more frequent bleeding points (71%) than oral-side incision lines (11-12 o'clock; 29%). Additional endoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellent hemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimate treatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should be carefully examined for bleeding points, even after the CSEMS placement.

Keywords: Endoscopic; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Hemostasis; Self-expandable metal stents

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