Partially covered vs uncovered sphincterotome and post-endoscopic sphincterotomy bleeding

Table 1 Risk factors for hemorrhage after endoscopic sphincterotomy[11]

Definite1	Maybe2	No3
Coagulopathy	Cirrhosis	ASA or NSAID
Anticoagulation < 3 d after ES	Dilated CBD	Ampullary tumor
Cholangitis prior ERCP	CBD stones	Longer length sphincterotomy
Bleeding during ES	Periampullary diverticulum	Extension of prior ES
Lower ERCP case volume	Precut sphincterotomy

¹Significant by multivariate analysis in most studies;

²Significant by univariate analysis only in most studies;

³Not significant by multivariate analysis. ERCP: Endoscopic retrograde cholangiopancreatography; CBD: Common bile duct; ES: Endoscopic sphincterotomy; ASA: Acetyl salicylic acid; NSAID: Nonsteroidal antiinflammatory drug.

Table 2 Baseline characteristics of patients

	Partially covered sphincterotome (n = 194)	Uncovered sphincterotome (n = 193)	P
Sex (M/F)	85/109	89/104	0.640
Age (mean ± SD) (yr)	69.93 ± 13.85	70.71 ± 13.75	0.590
Indications for ES			0.304
Choledocholithiasis	143	136	0.382
Pancreatic malignancy	20	26	0.356
Biliary malignancy	11	8	0.473
Papillary cancer	7	6	0.771
SOD	8	5	0.392
Bile leak	2	3	0.657
Metastatic lymphadenopathy	1	4	0.187
Others	2	5	0.255
Associated comorbid disease			0.561
Coronary artery disease	11	7	0.329
Hypertension	31	42	0.160
Diabetes	22	24	0.768
Heart failure	21	24	0.647
COPD	9	10	0.823
Renal failure	4	6	0.527
Renal failure in hemodialysis	2	-	0.155
Others	53	61	0.390

ES: Endoscopic sphincterotomy; SOD: Sphincter of Oddi dysfunction; COPD: Chronic obstructive pulmonary disease.

Table 3 Risk factors for post-endoscopic sphincterotomy bleeding between the two groups

	Partially covered sphincterotome (n = 194)	Uncovered sphincterotome (n = 193)	P
Definite
Anticoagulation < 3 d after ES	3	5	0.365
Bleeding during ES	24	19	0.408
Cholangitis prior to ERCP	26	21	0.425
"Zipper cut" phenomenon	4	3	0.497
Maybe
Papillary cancer	7	6	0.771
Cirrhosis	5	3	0.359
Dilated CBD	72	74	0.865
CBD stone	143	136	0.382
Periampullary diverticulum	38	44	0.472
Precut (suprapapillary) sphincterotomy with extension	10	6	0.302

ES: Endoscopic sphincterotomy; ERCP: Endoscopic retrograde cholangiopancreatography; CBD: Common bile duct.

Table 4 Patterns of post-endoscopic sphincterotomy bleeding

	Partially covered sphincterotome (n = 26)	Uncovered sphincterotome (n = 20)	P
Immediate	24	19	0.418
Trickle	14	12	0.748
Ooze	9	7	0.965
Pulsatile	1	-	0.558
Delayed	2	1	0.620

Table 5 Risk factors for post-endoscopic sphincterotomy hemorrhage of patients presenting with immediate bleeding

	Partially covered sphincterotome (n = 24)	Uncovered sphincterotome (n = 19)	P
Definite
Anticoagulation < 3 d after ES	2	3	0.373
Cholangitis prior to ERCP	7	5	0.883
"Zipper cut" phenomenon	1	1	1.000
Maybe
Cirrhosis	1	-	0.565
Dilated CBD	12	14	0.106
CBD stone	21	16	0.590
Periampullary diverticulum	6	7	0.373
Precut (suprapapillary) sphincterotomy with extension	-	1	0.435

ES: Endoscopic sphincterotomy; ERCP: Endoscopic retrograde cholangiopancreatography; CBD: Common bile duct.

Table 6 Complications

	Partially covered sphincterotome(n = 194)	Uncoveredsphincterotome(n = 193)	P
Pancreatitis	13	10	0.23
Mild	10	8
Moderate	2	1
Severe	1	1
Perforation	1	-	0.50
Cholangitis	1	3	0.31
Bleeding	26	20	0.36
Mild	26	20
Moderate	-	-
Severe	-	-
Basket impaction	1	-	0.50