Hemoclip treatment for post-endoscopic sphincterotomy bleeding.

Background: The incidence of bleeding after endoscopic sphincterotomy (EST) ranges from 2%-12.1%. Endoscopic treatments include injection and thermal therapy, which can have recurrent bleeding and potential complications of chemical and thermal injuries. There is only 1 case report of post-EST bleeding managed by hemoclipping in the literature. Treatment of post-EST bleeding with hemoclip is reported in this study.

Methods: From March 1999 to May 2003, a retrospective analysis of 162 cases of EST was made. Nine cases (5.5%) of post EST bleeding, 7 male and 2 female patients, with a mean age of 58 +/- 16 (37-82) years, were treated with hemoclipping. Four cases of recurrent bleeding were treated with secondary clipping when previous local epinephrine injection was ineffective, and the remaining 5 cases were managed with primary hemoclipping.

Results: Six cases were of major bleeding; 3 needed blood transfusion (mean: 7.3 units: 6-8 units) and 3 had a reduction of hemoglobin > 2 g/dL but without blood transfusion. The location of bleeder was 5 on the left side, 2 on the right side and 1 in both flaps of post-EST papilla. The median clips used were 2 (1-7), and the median missed clips were 0.5 (0-3). The success rate hemostasis was 88.8%, including 4 recurrent major bleeding after previous local epinephrine injection. Some technical difficulties were encountered. The failed case that underwent operation was due to total inability to get a visual field because of massive bleeding. There were no complications related to hemoclipping.

Conclusions: Hemoclipping can be an alternative method for hemostasis in post-EST bleeding.