Antiagregan ve Antikoagülan Tedavi Alan Hastalarda Endoskopik Retrograd Kolanjiyopankreatografi İşlemi Sonrası Kanama Komplikasyonlarının Değerlendirilmesi

Abstract

Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure has become an important interventional procedure for biliary and pancreatic duct diseases. In addition to its important therapeutic indications, a variety of procedure-related adverse events have been reported, which have decreased over the years thanks to advances in science, technical equipment and experience. Bleeding complications related to endoscopic sphincterotomy (ES) performed with ERCP procedure are gaining importance due to the widespread use of antiaggregant and anticoagulant drugs. To optimize the risk of bleeding associated with these drugs, several guidelines have made recommendations regarding the management of drugs before and after the procedure. In this study, 666 adult patients who underwent ERCP procedure and underwent endoscopic sphincterotomy in Hacettepe University Faculty of Medicine Endoscopy Unit between May 2018 and December 2021 were included, and it was aimed to determine the risk factors that may be associated with bleeding, as well as the relationship between the use of antiaggregant and anticoagulant drugs and bleeding complications. Of the 666 patients included in the study, 365 (54.8%) were female and the median age was 58.5 years. In addition, 76 (11.4%) of the patients were using at least one antiaggregant or anticoagulant drug. Bleeding complications were detected in 17 (2.6%) patients. While 58% (n=10) of these hemorrhages were observed during the procedure, 42% (n=7) presented as late bleeding. The majority of patients with clinical bleeding were mild (70%, n=12). No bleeding-related mortality was detected. A statistically significant correlation was found between prophylactic NSAID administration (OR: 3.89, CI: 1.36-11.13, p=0.011), antiaggregant drug use (OR: 6.43, CI: 1.52-27.05, p=0.011), anticoagulant drug use (OR: 7.12, CI: 1.9-26.7, p=0.004), sepsis (OR: 19.2, CI: 2.98-123.7, p=0.002), creatinine levels (0.73 vs. 0.88, IQR 0.30 vs. 0.25, p=0.016) and bleeding complications. Even if the guidelines for the correct use of antiaggregant and anticoagulant drugs with endoscopic procedures were followed, there was an independent factor increasing the risk of bleeding. Patients using these drugs should be followed carefully in terms of bleeding.