Post-Endoscopic Retrograde Cholangiopancreatography Bleeding After Endoscopic Stone Removal in Dialysis Patients: A Multicenter Retrospective Study.
Intraoperative bleeding and continued aspirin use are associated with post-ERCP bleeding in dialysis patients, indicating the need for careful hemostatic management.
Where it sits
this study against the rest of the igf-1 des (des(1-3) igf-1) corpusSummary and findings
This study examined risk factors for post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding in 102 dialysis patients undergoing endoscopic stone removal. The study found that intraoperative bleeding and continued aspirin use were associated with post-ERCP bleeding. Adverse events occurred in 23% of patients, with bleeding reported in 8%.
Abstract
<h4>Objectives</h4>Post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding occurs more frequently in dialysis patients than in non-dialysis patients. This study aimed to identify risk factors for post-ERCP bleeding following stone removal in patients undergoing dialysis.<h4>Methods</h4>This multicenter retrospective study enrolled 102 consecutive dialysis patients who underwent endoscopic stone removal at seven institutions between January 2009 and March 2022. Baseline characteristics, procedural details, stone removal outcomes, adverse events (AEs), and risk factors for post-ERCP bleeding were analyzed.<h4>Results</h4>Of the 102 patients, 65 were men. Median patient age was 77 years (range, 51-91 years). Antithrombotic drugs were administered to 64 patients (63%). Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and endoscopic papillary large balloon dilation were performed in 58 (57%), 20 (20%), and 11 (11%) patients, respectively. AEs occurred in 23 patients (23%), including bleeding in eight patients (8%), acute pancreatitis in nine patients (9%), cholangitis in seven patients (7%), and others in two patients (2%). Multivariate analysis identified intraoperative bleeding and continued aspirin use as independent risk factors for post-ERCP bleeding. Similar associations were observed in subgroup analyses restricted to patients with a naïve papilla.<h4>Conclusions</h4>Intraoperative bleeding and continued aspirin use were associated with post-ERCP bleeding following stone removal in dialysis patients, highlighting the importance of careful periprocedural hemostatic management in this population.<h4>Trial registration</h4>Not applicable.
Background
This paper addresses the frequency and risk factors for post-ERCP bleeding specifically in dialysis patients, a group previously noted to experience higher rates of such complications compared to non-dialysis patients. Prior studies have suggested that various factors, including the use of antithrombotic medications, may contribute to this increased risk. Understanding these factors is crucial for improving patient management and outcomes in this vulnerable population.
Methods
This multicenter retrospective study included 102 consecutive dialysis patients who underwent endoscopic stone removal across seven institutions. The study analyzed baseline characteristics, procedural details, outcomes of stone removal, adverse events, and identified risk factors for post-ERCP bleeding. No specific details on the dose or route of any medications were provided.
Results
Of the 102 patients, 65 were men, and 63% were administered antithrombotic drugs. Adverse events occurred in 23 patients, with bleeding in eight patients, acute pancreatitis in nine, and cholangitis in seven. Multivariate analysis revealed intraoperative bleeding and continued aspirin use as independent risk factors for post-ERCP bleeding.
Interpretation
The findings suggest that intraoperative bleeding and the continuation of aspirin therapy are significant risk factors for post-ERCP bleeding in dialysis patients. While the statistical significance of these findings is clear, the clinical significance may vary depending on individual patient circumstances. Limitations such as the retrospective design and potential confounding factors should be considered when applying these findings in practice.
Key findings
- 102 dialysis patients enrolled from January 2009 to March 2022.
- Median age was 77 years (range, 51-91 years).
- Adverse events occurred in 23 patients (23%).
- Bleeding occurred in eight patients (8%).
- Intraoperative bleeding and continued aspirin use identified as independent risk factors for post-ERCP bleeding.
Limitations
- Retrospective study design.
- Potential confounding factors not controlled for.
- Single-site data may limit generalizability.
- No information on long-term outcomes.