Year 2024 / Volume 116 / Number 10
Letter
Delayed post-sphincterotomy bleeding: hemostatic powder is a safe and effective option

582-583

DOI: 10.17235/reed.2024.10161/2023

Mara Sarmento Costa, Andrea Silva, Luís Santos, Nuno Almeida, Dário Gomes, Pedro Figueiredo,

Abstract
We present the case of a 72-year-old woman admitted for epigastric pain, elevated inflammatory parameters and liver enzymes, with a total bilirubin of 6mg/dL. Abdominal ultrasound identified cholelithiasis and posteriorly endoscopic ultrasound showed a 5.8mm stone distally in the biliary tract. Due to acute cholangitis, she underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, successfully removing the stone. Mild self-limited bleeding after sphincterotomy was reported, for which an adrenaline flush of the biliary tract was performed. The following day, she presented melena and hemoglobin dropped 3g/dL, remaining hemodynamically stable. With side-viewing duodenoscopy we identified an adherent clot and an oozing bleed near the pancreatic duct opening. The clot was removed with a snare after adrenalin injection and 3 endoclips of 8mm were positioned in the superior portion of the sphincterotomy. Even then, bleeding persisted. We opted to apply hemostatic powder (Hemospray®) with successful bleeding cessation. Four days later the patient was released without bleeding recurrence or suspected biliary blockage.
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References
1 - Law R, Cardenas A. Hemostatic Powder for Gastrointestinal Bleeding: Time to believe the hype or more false hope? Digestive and liver disease 2020;52:702–703. DOI: 10.1016/j.dld.2020.03.006.
2 - Falcão D, Ferreira D, Maia L, et al. Hemostatic spray as a therapy for pancreatic stump bleeding after cephalic duodenopancreatectomy. Rev Esp Enferm Dig 2023;115:456-457. DOI: 10.17235/reed.2022.9249/2022.
3 - Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020;52:127–149. DOI: 10.1055/a-1075-4080.
4 - Baract FI, Tranquillini CV, Brunaldi VO, et al. Hemostatic powder: a new ally in the management of postsphincterotomy bleeding. VideoGIE 2017;2:303–304. DOI: 10.1016/j.vgie.2017.07.002.
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Costa M, Silva A, Santos L, Almeida N, Gomes D, Figueiredo P, et all. Delayed post-sphincterotomy bleeding: hemostatic powder is a safe and effective option. 10161/2023


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Publication history

Received: 11/12/2023

Accepted: 18/12/2023

Online First: 11/01/2024

Published: 09/10/2024

Article Online First time: 31 days

Article editing time: 303 days


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