Treating delayed endoscopic sphincterotomy-induced bleeding: Epinephrine injection with or without thermotherapy

Table 1 Clinical characteristics of patients in the two groups (mean ± SD)

	Epinephrine injection group (n = 26)	Combination therapy group (n = 33)	P value
Age (yr)	60.6 ± 18.1	56.1 ± 14.2	0.30
Gender (Male/Female)	14/12	20/13	0.60
Indications			0.48
Choledocholithiasis	22	24
Malignant obstruction	2	3
Others	2	6
Possible bleeding risk factors
Coagulopathy1	6	7	0.86
Bile duct stones	22	24	0.27
Precut sphincterotomy	1	6	0.12
Periampullary diverticulum	4	4	0.72
Bleeding during ES2	11	15	0.81
Cholangitis before procedure	11	16	0.64

¹Coagulopathy including: prolonged prothrombin time > 3 s of the control value; Platelet count < 80 000/μL; end-stage renal disease requiring hemodialysis;

²All post-ES bleeding occurred during ERCP and required endoscopic hemostasis. ES: Endoscopic sphincterotomy.

Table 2 Bleeding severity, and bleeding stigmata at initial endoscopy

	Epinephrine injection group (n = 26)	Combination therapy group (n = 33)	P value
Bleeding severity			0.61
Mild	9	9
Moderate	10	17
Severe	7	7
Bleeding stigmata			0.70
Active oozing	12	12
Oozing under an adherent clot	6	7
Non-bleeding visible vessel	0	1
Non-bleeding clot	4	9
Non-bleeding red spots	4	4

Table 3 Clinical outcomes according to endoscopic therapy (mean ± SD) n (%)

	Epinephrine injection group (n = 26)	Combination therapy group (n = 33)	P value
Initial hemostasis	25 (96.2)	33 (100)	0.44
Re-bleeding1	4 (16.0)	4 (12.1)	0.72
Embolization or surgery	3 (11.5)	1 (3.0)	0.31
Bleeding-related death	0	0	1
Transfusion requirement (U)	3.5 ± 4.6	3.5 ± 4.5	0.94

¹Re-bleeding after initial successful therapeutic endoscopy.