Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding

Table 1 Associations between re-bleeding and patient characteristics n (%)

	Re-bleeding	No re-bleeding	P value
	(n = 35)	(n = 126)
Age (yr)	63.0 (52.0-70.0)	57.0 (46.5-71.0)	0.121
Sex (male)	23 (65.7)	82 (65.1)	0.944
White blood cell count (× 103/μL)	8.1 (5.6-10.0)	8.1 (6.0-10.7)	0.673
Platelet count (× 103/μL)	225 (122-262)	215 (160-268)	0.320
INR	1.1 (1.0-1.5)	1.1 (1.0-1.2)	0.075
Total bilirubin (mg/dL)	10.9 (2.3-22.3)	6.5 (1.1-15.8)	0.002
ESRD	3 (8.6)	10 (7.9)	1.000
Decompensated liver cirrhosis	4 (11.4%)	4 (3.2)	0.047
Use of anti-platelet regimen
Before ES	3 (8.6)	3 (2.4)	0.117
Within 3 d after ES	2 (5.7)	2 (1.6)	0.206
Cholangitis before ES	13 (37.1)	58 (46.0)	0.349
Bleeding diathesis	16 (45.8)	22 (17.5)	< 0.001

ESRD: End stage renal disease; INR: International normalized ratio; ES: Endoscopic sphincterotomy.

Table 2 Associations between re-bleeding and endoscopic retrograde cholangopancreatography n (%)

	Re-bleeding	No re-bleeding	P value
	(n = 35)	(n = 126)
Endoscopic diagnosis
Choledocholithiasis	18 (51.4)	86 (69.0)	0.066
Malignant biliary stricture	11 (31.4)	7 (5.6)	< 0.001
Benign biliary stricture	3 (8.6)	8 (7.1)	0.706
Biliary leak	0 (0.0)	1 (0.8)	1.000
Others	4 (11.4)	24 (19)	0.571
Periampullary diverticulum	6 (17.1)	23 (18.3)	0.880
Immediate post-ES bleeding	14 (40.0)	40 (31.7)	0.360
Needle knife precut sphincterotomy	6 (17.1)	13 (10.3)	0.372

ERCP: Endoscopic retrograde cholangopancreatography; INR: International normalized ratio; ES: Endoscopic sphincterotomy.

Table 3 The association between re-bleeding and bleeding stigmata/treatment methods at initial endoscopic treatment for delayed bleeding n (%)

	Re-bleeding	No re-bleeding	P value
	(n = 35)	(n = 126)
Bleeding severity			< 0.001
Mild	1 (2.9)	46 (36.5)
Moderate	15 (42.9)	65 (51.6)
Severe	19 (54.3)	15 (11.9)
Features of ES wound
Active bleeding	27 (77.1)	85 (67.5)	0.271
Non-bleeding visible vessel	4 (11.4)	4 (3.2)	0.047
Non-bleeding adherent clot	4 (11.4)	23 (18.3)	0.517
Non-bleeding red spots	0 (0.0)	14 (11.1)	0.041
Type of endoscopic therapy
Monotherapy	13 (37.1)	59 (46.8)	0.342
Epinephrine injection	7 (20.0)	45 (35.7)	0.102
Thermocoagulation	6 (17.1)	14 (11.1)	0.385
Combination therapy1	22 (65.7)	67 (53.2)	0.342
Thermocoagulation	21 (60.0)	64 (50.8)	0.347
Hemoclipping	0 (0.0)	1 (0.8)	1.000
Thermotherapy + hemoclipping	1 (2.9)	2 (1.6)	1.000

¹Including dilute epinephrine injection plus one of the three types of therapy. ES: Endoscopic sphincterotomy.

Table 4 Univariate and multivariate analyses for predictors of re-bleeding

Predictor	Univariate			Multivariate
	OR	95%CI	P value	OR	95%CI	P value
Malignant biliary stricture
No	1
Yes	7.79	2.74-22.14	< 0.001
Serum bilirubin level1
≤ 10	1			1
> 10	4.7	2.06-10.72	< 0.001	3.55	1.39-9.11	0.008
Bleeding severity
Mild	1			1
Moderate	10.62	1.354-83.22	0.025	10.97	1.379-87.18	0.024
Severe	58.27	7.18-472.79	< 0.001	48.74	5.90-402.93	< 0.001
Bleeding diathesis
No	1
Yes	3.98	1.77-8.94	< 0.001

¹A serum bilirubin level > 10 mg/dL was associated with area under the receiver operating characteristic curve of 0.678 (95%CI: 0.57-0.78, P = 0.002).

Table 5 Treatment outcomes n (%)

	Overall (n = 35)
Successful endoscopic hemostasis	29 (82.9)
Only 1 session	23
More than 1 session	6
Mean endoscopic session (range)	2.34 (2-7)
TAE/surgery required for hemostasis	4/1 (14.3)
Bleeding-related death	1 (2.8)

TAE: Transarterial embolization.