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01-11-2014 | Interventional

Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome

Authors: Geert Maleux, Jurgen Bielen, Annouschka Laenen, Sam Heye, Johan Vaninbroukx, Wim Laleman, Peter Verhamme, Alexander Wilmer, Werner Van Steenbergen

Published in: European Radiology | Issue 11/2014

Abstract

Purpose

To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality.

Materials and methods

From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected.

Results

Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012).

Conclusion

Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival.

Key Points

• Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding

• The rate of rebleeding is acceptably low

• Haemostatic disorders appear to significantly influence 30-day survival

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Title: Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome
Authors: Geert Maleux
Jurgen Bielen
Annouschka Laenen
Sam Heye
Johan Vaninbroukx
Wim Laleman
Peter Verhamme
Alexander Wilmer
Werner Van Steenbergen
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 11/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3332-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

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