⁎⁎Invited to participate in the poster session of the asge meeting.4619 Hemorrhage after endoscopic sphincterotomy: risk factors and endoscopic managenent - final results of a prospective study.

To determine risk factors (RF) for hemorrhage after endoscopic sphincterotomy (EST) and to evaluate the outcome of therapeutic modalities. METHODS: In all consecutive EST procedures between 09/94 and 12/98 indications, techniques, success, complications of EST, and possible RF for hemorrhage were evaluated prospectively. Pts. were followed up by physical examination and blood samples at 4, 24 and 48 hours after EST. Complications were classified according to commonly accepted criteria (Gastrointest Endosc 1991: 338). Risk factor analysis was performed using univariate methods. RESULTS: In 815 pts. (53.3% m, 46.7% f, 61±17 y); complications occured in 9.9% (81/815; 69 mild-moderate; 11 severe; 4 fatal). Bleeding during the procedure was seen in 50 pt. (self-limiting in 35 cases, successful injection therapy in 15 pt). The incidence of hemorrhage (drop of hemoglobin of at least 2 g/dl and clinical signs of hemorrhage) was 1.6% (14/815; 7 mild-moderate; 5 severe; 2 fatal). Hemorrhage was detected only in 2 pt., who showed bleeding during EST (both with prior injection therapy), and in 12 pt. without signs of bleeding during EST. The clinical onset of hemorrhage was within 4 hours after EST in 5 pt., within 2 days in 4 pt., and within 4 to 10 days in 5 pt. Univariate analysis obtained 2 RF for hemorrhage: coagulopathy (thrombocytes<50.000 or prothrombintime<50%; 2/11, p=0.019) and intensive-care-pt. before EST (2/13, p<0.014). Additionally prior gastrectomy (2/28, p<0.080) increased the incidence of hemorrhage, and EST<5mm decreased the incidence (1/256; p=0.076). CONCLUSIONS: Bleeding during EST mainly stops spontaneously, and if not, injection therapy is effective. However bleeding was no significant risk factor for later hemorrhage. Hemorrhage showed in up to one third of pt. a late onset, and was significantly associated with risk factors. Thus, in pts. with risk factors for hemorrhage, alternative access procedures like papillary dilation should be considered.