| 067 |
|
BLEEDING AFTER SPHINCTEROTOMY: RETROSPECTIVE COMPARISON BETWEEN TWO TYPES OF ELECTROSURGICAL CAUTERY
RF Perini, PB Cotton, KM Payne, RS Patel, RH Hawes, JT Cunningham
Division of Gastroenterology/Hepatology DDC MUSC, Charleston, South Carolina
BACKGROUND: Electrocautery technique may affect bleeding complication after sphincterotomy. We were interested to see the effect of the introduction of a new system on the bleeding rate.
METHODS: A retrospective analysis of an ERCP database was made comparing the incidence of immediate and delayed bleeding between two periods when different generators were used. The conventional electrocautery SSEL2 (ValleyLab, Boulder, CO) was used up to November 1997, when the ICC 200 (ERBE, Marietta, GA) generator was introduced. Clinical and technical risk factors were also analyzed.
RESULTS: 6127 ERCPs were performed from February 1994 to September 2000. During this period, 2680 biliary and pancreatic sphincterotomies were done, 90% of them with no complication. Immediate bleeding occurred more common in the SSEL2 group (OR=5.28, p<0.005, CI=2.88 – 10.49). Potentially confounding variables was the change in the biliary pancreatic sphincterotomy ratio over time and size of sphincterotomy. Delayed bleeding was identified in nine patients in each group (p>0.5). No statistical difference was found in the coagulation status as well as in the type, size and site of the sphincterotomy. Three patients who had delayed bleed, also had immediate bleeding, all of them in the SSEL2 group.
CONCLUSION: The ERBE generator was associated with a significantly lower incidence of early acute bleeding after sphincterotomy (p<0.005). There was no difference in the delayed bleeding rate.