Factors Associated with Bleeding after Endoscopic Retrograde Cholangiopancreatography: A Cross-Sectional Study

Abstract

Background:

Bleeding after endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication that requires identification of its underlying factors. We aimed to investigate the incidence and predictors of this complication in our center.

Materials and Methods:

 We conducted a descriptive cross-sectional study on 500 patients who underwent ERCP for any indication at Firoozgar Hospital in 2020-2021. We collected data on demographic characteristics, medical history, medications, preoperative hemoglobin, and indication for ERCP from the hospital records. We also measured intraoperative bleeding, sphincterotomy, and hemoglobin levels at 6 hours and one week after ERCP. We used SPSS software for data analysis and considered P< 0.05 statistically significant.

Results:

The mean ± SD age of the patients was 60.37 ± 16.37 years, and 50.8% were male. The incidence of acute and delayed bleeding after ERCP was 4.2% and 0.6%, respectively, and the rate of acute and delayed moderate to severe hemoglobin drop was 7.8% and 13%, respectively. There was no difference in demographic information, medical history, and medications between patients with and without acute and delayed hemoglobin drop. However, patients with a history of diabetes mellitus had a higher rate of mild delayed bleeding, and patients with smoking and clopidogrel use had a higher rate of moderate to severe hemoglobin drop (P< 0.05). Sphincterotomy, precut, peri-ampullary anatomy, and common bile duct (CBD) size did not affect the incidence of acute and delayed bleeding and hemoglobin drop.

Conclusion:

 Diabetes mellitus was the only risk factor for delayed bleeding, and smoking and clopidogrel were risk factors for moderate to severe hemoglobin drop. Due to the discrepancy between overt and laboratory bleeding in this study, we recommend regular hemoglobin monitoring as a more accurate indicator of bleeding after ERCP.