Treatments for bleeding during endoscopic sphincterotomy
10.3877/cma.j.issn.2095-3232.2018.02.010
- VernacularTitle:内镜下乳头括约肌切开术中出血的治疗
- Author:
Chuang WANG
1
;
Xiaohua ZHOU
;
Jinke YAO
;
Jianping LIU
Author Information
1. 511300,广州市增城区人民医院普通外科
- Keywords:
Sphincterotomy,endoscopic;
Hemostasis;
Treatment outcome
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2018;7(2):123-126
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the cause and hemostasia for bleeding during endoscopic sphincterotomy (EST). Methods Clinical data of 90 patients undergoing EST and suffering from intraoperative bleeding in the Second Affiliated Hospital of Guangzhou Medical University between January 2013 and October 2016 were analyzed retrospectively. There were 48 males and 42 females with a mean age of (51±2) years. The informed consents of all patients were obtained and the local ethical committee approval was received. The bleeding part, bleeding cause and efficacy of different hemostasia in EST patients were obsesrved. Comparison of rates was conducted by Chi-square test. Results 72 cases were observed with definite bleeding points, including 51 cases' bleeding part was at the papilla 10-2 o'clock direction, 10 cases at 2-6 o'clock direction, and 11 cases 6-10 o'clock direction. 18 cases were observed with diffuse bleeding. The bleeding causes included inaccurate direction, excessively deep knife cut, excessively high knife bow,and excessively large incision. All patients were cured, including 40 cases of titanium clip hemostasis with a success rate 97%(39/40), 31 cases of electric coagulation hemostasis with a success rate 81%(25/31), 14 cases of thermal probe hemostasis with a success rate 71%(10/14), 10 cases of fibrin glue infusion with a success rate 7/10, 10 cases of 1:10 000 epinephrine sub-mucosal injection with a success rate 5/10, 6 cases of local compression with spherical sacculus, with a success rate 3/6, and 1 case receiving operative hemostatis. Endoscopic titanium clip hemostatis, electric coagulation hemostatis and thermal probe hemostatis had definite effects. The success rate of titanium clip hemostatis was obviously higher than electric coagulation hemostatis (χ2=11.813, P=0.008). Titanium clip hemostatis was particularly applicable to patients with exposed bleeding vessel, while electric coagulation and thermal probe hemostatis were applicable to patients with errhysis. Conclusion Duodenal papilla bleeding, as a common postoperative complication of EST, endoscopic titanium clip hemostatis, electric coagulation hemostatis and thermal probe hemostatis had relatively definite effects.
