Prevention of post‐sphincterotomy bleeding by proton pump inhibitor: A randomized controlled trial

OBJECTIVE Post‐endoscopic sphincterotomy (EST) bleeding is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). Although the use of proton pump inhibitors (PPIs) reduces the risk of peptic ulcer bleeding, their role in preventing EST bleeding has not been...

Full description

Saved in:
Bibliographic Details
Published in:Journal of digestive diseases 2018-06, Vol.19 (6), p.369-376
Main Authors: Leung, Wai K, But, David YK, Wong, Siu‐Yin, Tong, Teresa SM, Liu, Kevin SH, Cheung, Ka‐Shing, Tsang, Simon HY, Chok, Kenneth SH, Poon, Ronnie TP, Hung, Ivan FN
Format: Article
Language:English
Subjects:
Bleeding
Blood transfusion
endoscopic retrograde cholangiopancreatography
endoscopic sphicterotomy
Endoscopy
esomeprazole
gastrointestinal hemorrhage
Health risk assessment
Hemoglobin
Intravenous administration
Omeprazole
papillotomy
Proton pump inhibitors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:OBJECTIVE Post‐endoscopic sphincterotomy (EST) bleeding is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). Although the use of proton pump inhibitors (PPIs) reduces the risk of peptic ulcer bleeding, their role in preventing EST bleeding has not been evaluated. This study aimed to assess the use of pre‐emptive PPIs in patients undergoing EST. METHODS This was an investigator‐initiated, open‐label, randomized study. Consecutive patients scheduled to undergo ERCP and EST were enrolled after excluding those who had previous EST or used acid‐suppression agents. Eligible patients were randomized to receive either PPI or standard care. The PPI group received intravenous esomeprazole 4 h before the EST and then every 12 h for 1 day, followed by high‐dose oral esomeprazole for 10 days. All patients were followed up for 30 days. The primary outcome was the proportion of patients with combined immediate and delayed overt post‐EST bleeding. RESULTS Altogether 125 patients (60 in the PPI arm and 65 in the standard care arm) who had undergone EST were analyzed. Immediate bleeding was noted in nine (15.0%) patients in the PPI group and four (6.2%) in the standard care group (P = 0.14). Overt delayed post‐EST bleeding was seen in two (3.3%) and five (7.7%) patients in PPI and standard care arms, respectively (P = 0.44). There were no significant differences in other outcomes, including a decrease in hemoglobin of >20 g/L, the need for blood transfusion, length of hospital stay and 30‐day mortality. CONCLUSION Pre‐emptive PPI did not reduce the risk of post‐EST bleeding.
ISSN:1751-2972
1751-2980
DOI:10.1111/1751-2980.12604