Background: One major adverse event of endoscopic sphincterotomy (EST) is bleeding, which could be more common and severe in patients receiving anticoagulant therapy. However, the cessation of anticoagulants for long periods could lead to thromboembolic events. We aimed to evaluate the optimal timing of resumption of anticoagulants after EST in patients at risk for thromboembolism.
Materials And Methods: From January 2010 through October 2017, a retrospective cohort at risk for thromboembolism who had taken warfarin and bridging therapy with heparin around EST from three tertiary hospitals in South Korea was investigated. The primary outcome was to compare the incidence of post-EST delayed bleeding according to the resumption time of anticoagulant. The secondary outcome was to investigate any thromboembolic adverse events related to interruption of the anticoagulant.
Results: A total of 96 patients (46 males and 50 females; median age 75 years [range, 24-91 years]) were enrolled. Overall, the patient numbers of very early (< 24 h), early (24-48 h), and late resumption (> 48 h) of anticoagulant after EST were 56, 23, and 17, respectively. The baseline characteristics were similar between groups except resumption time of anticoagulant. There was no significant difference in the rate of post-EST delayed bleeding (5% in very early group vs. 9% in early group vs. 0 in late group, p = 0.47). The rate of thromboembolic adverse events was significantly higher in the late resumption of anticoagulant group (0 vs. 0 vs. 24%, p < 0.001).
Conclusion: There was no significant difference in the incidence of post-EST delayed bleeding according to the resuming time of anticoagulant. Since long cessation of anticoagulant could increase the risk of thrombotic adverse events, the early resumption of anticoagulant seems to be preferred.
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http://dx.doi.org/10.1007/s00464-018-6129-9 | DOI Listing |
Gastroenterol Clin North Am
March 2025
Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, California, USA. Electronic address:
Although endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be a safe and effective approach in treating these diseases while carrying lower morbidity than traditional surgical treatments, ERCP has associated risks, with post-ERCP pancreatitis (PEP) being the most common serious adverse event and carries significant morbidity and health care cost. PEP results from multifactorial factors involving trauma to the pancreatic duct and papilla, leading to subsequent obstruction and impairment of pancreatic drainage. Important risk factors for PEP include history of prior PEP, suspected sphincter of Oddi dysfunction, difficult cannulation, pancreatic duct contrast injections, and pancreatic sphincterotomy.
View Article and Find Full Text PDFGastroenterol Clin North Am
March 2025
Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA. Electronic address:
Recurrent acute pancreatitis (RAP) is a complex syndrome that presents variably, with many cases remaining idiopathic after thorough diagnostics. For evaluating structural etiologies, endoscopic ultrasound and MR cholangiopancreatography are preferred over endoscopic retrograde cholangiopancreatography (ERCP) given their more favorable risk profile and sensitivity. The diagnostic work-up remains paramount since treatment should focus on addressing underlying causes such as early cholecystectomy for gallstone pancreatitis.
View Article and Find Full Text PDFWorld J Gastroenterol
January 2025
Department of Gastroenterology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, Guangdong Province, China.
Background: (), is a prevalent parasitic worm that infects humans. It is found all over the world, particularly in tropical and subtropical areas. Strongyloidiasis is caused mostly by the parasitic nematode .
View Article and Find Full Text PDFJ Clin Med
January 2025
Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason, Franciscan Health, Seattle, WA 98101, USA.
Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, such as endoscopic transpapillary gallbladder drainage (ETP-GBD), and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD), are effective. PT-GBD is associated with significant discomfort as well as variable adverse event rates.
View Article and Find Full Text PDFTurk J Gastroenterol
January 2025
Department of Gastroenterology, Harran University Faculty of Medicine, Şanlıurfa, Türkiye.
Background/aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential diagnostic and therapeutic method for pancreato-biliary disorders in adults, but its use in pediatric populations remains limited. This study aims to evaluate the indications, technical success, and safety of ERCP in pediatric patients.
Materials And Methods: A retrospective analysis of all ERCP procedures performed on patients under 18 years of age was conducted at 2 tertiary centers in Türkiye (Harran University and Gaziantep University Hospital) during the period between January 2013 and May 2024.
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