Clin Endosc > Epub ahead of print
Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding
Michihiro Yoshida1 , Tadahisa Inoue2 , Itaru Naitoh1 , Kazuki Hayashi1 , Yasuki Hori1 , Makoto Natsume1 , Naoki Atsuta1 , Hiromi Kataoka1
1Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
2Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
Correspondence :  Itaru Naitoh ,Tel: +81-52-853-8211, Fax: +81-52-852-0952, Email: inaito@med.nagoya-cu.ac.jp
Received: August 7, 2020  Revised: September 14, 2020   Accepted: September 22, 2020
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.
Key Words: Endoscopic; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Hemostasis; Self-expandable metal stents
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