Analysis of risk factors for post-endoscopic papillectomy bleeding

Abstract

Background

Endoscopic papillectomy (EP) is an effective treatment for ampullary lesions but technically challenging because of anatomical specificities concerning the high rate of adverse events. Bleeding is one of the most feared complications and can be potentially life-threatening.

Aim

To study the risk factors for bleeding after EP are presented with the goal of establishing preventive measures.

Methods

A total of 173 consecutive patients with ampullary lesions undergone EP from January 2006 to October 2020 were enrolled in this study. They were divided into a bleeding group and a non-bleeding group depending on whether postoperative bleeding occurred. Related factors were analyzed by univariate and multivariate logistics regression.

Results

Postoperative bleeding was experienced in 33 patients (19.07%). Multivariate analysis also identified intraoperative bleeding (OR: 4.38, 95% CI: 1.87–11.15, p = .001) and endoscopic closure (OR: 0.25, 95% CI: 0.10–0.58, p = .001) as independent factors significantly associated with bleeding after EP. Lesion size (≥3 cm) was shown as an independent factor significantly associated with intraoperative bleeding (OR: 4.25, 95% CI: 1.21–16.44, p = .028).

Conclusions

This retrospective evaluation found that endoscopic closure was associated with reduced risk and intraoperative bleeding with increased risk of bleeding after EP. Lesion size may indirectly influence the risk of postoperative bleeding by increasing the risk of intraoperative bleeding.

Keywords:

• Ampullary lesions
• endoscopic papillectomy
• bleeding
• risk factors
• wound closure

Acknowledgment

The authors thank all our supporting colleagues in the Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital.

Author contributions

Wen Li contributed to conception and design, endoscopic operation; Ting-ting Cui wrote and edited the manuscript; Wen Li, En-Qiang Ling-Hu, Feng-Chun Cai, Ming-Yang Li, and Ning-Li Chai performed the operations; Zi-kai Wang, Xiang-dong Wang assisted in operations; Nian-jun Xiao and Fang Liu completed data analysis and interpretation. Ning-Li Chai participated in revising the manuscript. En-Qiang Ling-Hu participated in design.

Institutional review board statement

The study was reviewed and approved by the Ethics Committee of the PLA General Hospital, No. S2021-441.

Informed consent statement

All study participants, or their legal guardian, provided informed written consent.

Disclosure statement

No conflicts of interest.

Data availability statement

No additional data are available.