A strategy to prevent post-endoscopic retrograde cholangiopancreatography bleeding in end-stage renal disease patients

Abstract Background: End-stage renal disease (ESRD) is a risk factor of post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding, which may prolong hospitalization or increase the mortality rate. Hemodialysis is known to correct platelet dysfunction from ESRD but whether it can decrease post-ERCP bleeding is still uncertain. Endoscopic papillary balloon dilation (EPBD) had been reported to decrease post-ERCP bleeding but lacks evidence on whether replacing endoscopic sphincterotomy (EST). Aims: To explore the predictive factors of post-ERCP bleeding and if hemodialysis could decrease post-ERCP bleeding in ESRD patients. Furthermore, to investigate if the post ERCP bleeding rate, the severity of hemorrhage, and difficulty of treatment differ between EST and EPBD. Materials and Methods: This retrospective study acquired patient data from Chang Gung Memorial Hospitals by using Chang Gung Research Database (CGRD) from January 1, 2010, to June 30, 2020. We enrolled ESRD patients who underwent EST or EPBD on the naïve major papilla. First, we analyze the protective factors to prevent post-ERCP bleeding. And to compare the severity of post-ERCP bleeding and difficulty of hemostatic treatment between EST or EPBD with bleeding. Results: Total 580 patients enrolled, and we found hemodialysis significantly decreased post ERCP bleeding in the group of eGFR < 15 mL / min / 1.73m2 (p = 0.039, OR = 0.65, 95% CI: 0.43–0.98). Although the bleeding incidence was similar between EST and EPBD groups, there were significantly more patients in the EST bleeding group who required invasive hemostasis procedures (p = 0.001, N = 30/41, 73.17%). Patients who required two or more hemostasis procedures, such as trans-arterial embolization or endoscopic hemostasis, were exclusively in the EST bleeding group. Conclusion: Hemodialysis can decrease post ERCP bleeding rate in patients with eGFR < 15 mL / min / 1.73m 2 . Although the bleeding incidence is similar between EST and EPBD in ESRD patients, hemostatic treatments were more complicated in EST with bleeding than in EPBD.