Background:

The incidence of post-sphincterotomy bleeding is variable, from 0.3-2%, increasing to 9.6% in some cases; with a mortality of 0.04%. Approximately 10-30% of sphincterotomies may present hemorrhage, immediate bleeding is generally self-limited, however, sometimes intra-procedure hemostasis is warranted; The different therapeutic options in these cases have not been standardized.

Objective:

To evaluate the efficacy of the use of balloon compression hemostasis compared with epinephrine injection in immediate post-sphincterotomy bleeding.

Material and methods:

Retrospective, observational and analytical study. All patients who presented immediate post-sphincterotomy bleeding from January 2017 to March 2020 were included and grouped according to the therapy used, the general characteristics, risk factors, initial hemostasis and rebleeding were evaluated; multivariate logistic regression was performed to identify risk factors for rebleeding.

Results:

A total of 60 patients divided into two groups: adrenaline = 21 patients and balloon = 39 patients. The incidence of immediate bleeding was 8.21% and initial hemostasis was achieved in 100% of the cases. Mild bleeding predominated in both groups (14 (66.6%) adrenaline group and 38 (97.4%) balloon group; p = 0.005). Only patients with moderate bleeding had rebleeding (7 (33.3%) adrenaline group and 1 (2.6%) balloon group, p = 0.001). In the multivariate analysis, ampullary edema had greater significance OR 6.5 (0.9-126 95% CI, p = 0.05). No adverse effects, complications or deaths were recorded.

Conclusions:

Balloon hemostasis is a useful, effective and safe tool, in some cases superior to epinephrine in the control of immediate post-sphincterotomy bleeding.

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