Analysis of risk factors for post-endoscopic papillectomy bleeding

• Published in: Scandinavian journal of gastroenterology 2022-11, Vol.57 (11), p.1367-1373
• Main Authors: Cui, Ting-Ting, Chai, Ning-Li, Cai, Feng-Chun, Li, Ming-Yang, Wang, Xiang-Dong, Xiao, Nian-Jun, Wang, Zi-Kai, Liu, Fang, Ling-Hu, En-Qiang, Li, Wen
• Format: Article
• Language: English
• Subjects: Ampulla of Vater - pathology; Ampulla of Vater - surgery; Ampullary lesions; bleeding; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; endoscopic papillectomy; Endoscopy - adverse effects; Humans; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Retrospective Studies; Risk Factors; Treatment Outcome; wound closure
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365521.2022.2085058

Endoscopic papillectomy (EP) is an effective treatment for ampullary lesions but technically challenging because of anatomical specificities concerning the high rate of adverse events. Bleeding is one of the most feared complications and can be potentially life-threatening. To study the risk factors for bleeding after EP are presented with the goal of establishing preventive measures. A total of 173 consecutive patients with ampullary lesions undergone EP from January 2006 to October 2020 were enrolled in this study. They were divided into a bleeding group and a non-bleeding group depending on whether postoperative bleeding occurred. Related factors were analyzed by univariate and multivariate logistics regression. Postoperative bleeding was experienced in 33 patients (19.07%). Multivariate analysis also identified intraoperative bleeding (OR: 4.38, 95% CI: 1.87-11.15, p = .001) and endoscopic closure (OR: 0.25, 95% CI: 0.10-0.58, p = .001) as independent factors significantly associated with bleeding after EP. Lesion size (≥3 cm) was shown as an independent factor significantly associated with intraoperative bleeding (OR: 4.25, 95% CI: 1.21-16.44, p = .028). This retrospective evaluation found that endoscopic closure was associated with reduced risk and intraoperative bleeding with increased risk of bleeding after EP. Lesion size may indirectly influence the risk of postoperative bleeding by increasing the risk of intraoperative bleeding.