Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2017; 9(4): 171-176
Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.171
Does serotonin reuptake inhibitor therapy increase the risk of post-sphincterotomy bleeding in patients undergoing endoscopic retrograde cholangio-pancreatography?
Divya Yadav, John Vargo, Rocio Lopez, Prabhleen Chahal
Divya Yadav, John Vargo, Prabhleen Chahal, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Rocio Lopez, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Yadav D designed the research, collected data, performed the research and drafted the manuscript; Lopez R analyzed the data; Vargo J critically revised the manuscript for important intellectual content; Chahal P designed the research, supervised the study and critically revised the manuscript for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Cleveland Clinic.
Informed consent statement: All study participants provided informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Prabhleen Chahal, MD, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code A31, 9500 Euclid Avenue, Cleveland, OH 44195, United States. chahalp@ccf.org
Telephone: +1-216-4446521 Fax: +1-216-4446284
Received: July 22, 2016
Peer-review started: July 25, 2016
First decision: October 20, 2016
Revised: December 16, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: April 16, 2017
Abstract
AIM

To evaluate the risk of immediate and delayed bleeding following sphincterotomy procedure.

METHODS

This retrospective cohort study was conducted with all patients who underwent endoscopic sphincterotomy during January 2006 to September 2015 at a tertiary academic center. Patients were grouped according to pre procedural usage of serotonin reuptake inhibitors (SRIs). Both groups were matched for demographic and clinical characteristics. Patients with thrombocytopenia, increased international normalized ratio, or a history of bleeding or coagulation disorders, concurrent use of other antiplatelet/anticoagulants were excluded from the study.

RESULTS

A total of 447 patients were included, of which 219 (45.9%) used SRIs and 228 (54.1%) cases did not. There was no significant difference in acute or delayed bleeding during endoscopic sphincterotomy between the two groups. (8.2% vs 12.3%, P = 0.16).

CONCLUSION

The use of SRIs was not associated with an increased risk of post-sphincterotomy bleeding. To our best knowledge, this is the first study to explore this association.

Keywords: Serotonin reuptake inhibitors, Post- sphincterotomy bleeding, Endoscopy, Endoscopic retrograde cholangiopancreatography, Gastrointestinal bleeding

Core tip: Serotonin reuptake inhibitors (SRIs) are a very commonly prescribed medication. The use of SRIs is reportedly associated with an increased risk for gastrointestinal bleeding in few studies. In this retrospective cohort study we analyzed the association between use of SRI and risk of post sphincterotomy bleeding with meticulous exclusion of all the confounders associated with increased risk of sphincterotomy bleeding. To our knowledge, this is a first study to assess the SRIs impact on post sphincterotomy bleeding.