Background

Placement of covered self-expandable metallic stent (CSEMS) for post-endoscopic sphincterotomy (ES) bleeding achieves excellent hemostasis results. Although CSEMS placement is typically performed after failure of conventional endoscopic combination therapy, its excellent outcomes may justify earlier placement.

Aims

We aimed to examine the efficacy of “early” CSEMS placement for massive post-ES bleeding.

Methods

The medical records of 2750 patients who underwent ES between 2005 and 2019 were reviewed retrospectively, and 61 patients who developed massive post-ES bleeding were enrolled. These patients were divided into those who underwent early CSEMS placement (E-CSEMS group) and those who underwent conventional endoscopic combination therapy (Conventional group). The outcomes of hemostasis procedures were compared between the groups.

Results

The primary success rates of endoscopic hemostasis were 100% (21/21) and 98% (39/40) in the E-CSEMS group and Conventional group, respectively, without significant differences (P = 1.000). However, in the E-CSEMS group, re-bleeding was significantly less frequent (5% vs. 31%; P = 0.023), the median hemostasis procedure time was significantly shorter (14 min vs. 26 min; P < 0.001), and transfusion after initial hemostasis treatment was less commonly required (10% vs. 38%; P = 0.034). Multivariate analyses showed that hemodialysis was associated with a significantly higher re-bleeding rate (P = 0.029), while CSEMS placement was associated with a significantly lower re-bleeding rate (P = 0.039).

Conclusions

Early CSEMS placement may be effective for improving the clinical outcomes of massive post-ES bleeding by decreasing re-bleeding and the extent of bleeding.

中文翻译：

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早期覆盖的自膨式金属支架置入术对于内镜下括约肌切开术大出血有效。

背景

内窥镜括约肌切开术（ES）出血放置有盖自膨胀金属支架（CSEMS）可获得出色的止血效果。尽管CSEMS放置通常在常规内窥镜联合治疗失败后进行，但其优异的结局可证明较早放​​置。

目的

我们旨在检查“早期” CSEMS植入对ES术后大出血的疗效。

方法

回顾性分析了2005年至2019年间2750例行ES的患者的病历，并纳入了61例发生ES后大出血的患者。这些患者分为接受早期CSEMS放置的患者（E-CSEMS组）和接受常规内镜联合治疗的患者（常规组）。在两组之间比较了止血程序的结果。

结果

E-CSEMS组和常规组的内镜止血成功率分别为100％（21/21）和98％（39/40），无显着性差异（P  = 1.000）。但是，在E-CSEMS组中，再次出血的频率显着降低（5％vs. 31％；P  = 0.023），中位止血时间明显缩短（14 min vs. 26 min；P  <0.001），最初止血治疗后的输血较少（10％比38％；P  = 0.034）。多因素分析显示，血液透析与较高的再出血率相关（P  = 0.029），而CSEMS植入与较低的再出血率相关（P = 0.039）。

结论

早期放置CSEMS可能通过减少再出血和出血程度来改善ES大量出血的临床效果。