Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding

  • Michihiro Yoshida (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Tadahisa Inoue (Department of Gastroenterology, Aichi Medical University) ;
  • Itaru Naitoh (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Kazuki Hayashi (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Yasuki Hori (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Makoto Natsume (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Naoki Atsuta (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Hiromi Kataoka (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences)
  • Received : 2020.08.07
  • Accepted : 2020.09.22
  • Published : 2022.01.30
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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.

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References

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