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Article: Prevention of post-sphincterotomy bleeding by proton pump inhibitor: A randomized controlled trial

TitlePrevention of post-sphincterotomy bleeding by proton pump inhibitor: A randomized controlled trial
Authors
KeywordsEndoscopic retrograde cholangiopancreatography
Endoscopic sphicterotomy
Esomeprazole
Gastrointestinal hemorrhage
Papillotomy
Issue Date2018
PublisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1751-2980
Citation
Journal of Digestive Diseases, 2018, v. 19 n. 6, p. 369-376 How to Cite?
AbstractOBJECTIVE: Post‐endoscopic sphincterotomy (EST) bleeding is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). Although the use of proton pump inhibitors (PPIs) reduces the risk of peptic ulcer bleeding, their role in preventing EST bleeding has not been evaluated. This study aimed to assess the use of pre‐emptive PPIs in patients undergoing EST. METHODS: This was an investigator‐initiated, open‐label, randomized study. Consecutive patients scheduled to undergo ERCP and EST were enrolled after excluding those who had previous EST or used acid‐suppression agents. Eligible patients were randomized to receive either PPI or standard care. The PPI group received intravenous esomeprazole 4 h before the EST and then every 12 h for 1 day, followed by high‐dose oral esomeprazole for 10 days. All patients were followed up for 30 days. The primary outcome was the proportion of patients with combined immediate and delayed overt post‐EST bleeding. RESULTS: Altogether 125 patients (60 in the PPI arm and 65 in the standard care arm) who had undergone EST were analyzed. Immediate bleeding was noted in nine (15.0%) patients in the PPI group and four (6.2%) in the standard care group (P = 0.14). Overt delayed post‐EST bleeding was seen in two (3.3%) and five (7.7%) patients in PPI and standard care arms, respectively (P = 0.44). There were no significant differences in other outcomes, including a decrease in hemoglobin of >20 g/L, the need for blood transfusion, length of hospital stay and 30‐day mortality. CONCLUSION: Pre‐emptive PPI did not reduce the risk of post‐EST bleeding.
Persistent Identifierhttp://hdl.handle.net/10722/256352
ISSN
2019 Impact Factor: 1.736
2015 SCImago Journal Rankings: 0.781
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLeung, WK-
dc.contributor.authorBut, YKD-
dc.contributor.authorWong, SY-
dc.contributor.authorTong, SM-
dc.contributor.authorLiu, SHK-
dc.contributor.authorCheung, KSM-
dc.contributor.authorTsang, HYS-
dc.contributor.authorChok, KSH-
dc.contributor.authorPoon, RTP-
dc.contributor.authorHung, FNI-
dc.date.accessioned2018-07-20T06:33:18Z-
dc.date.available2018-07-20T06:33:18Z-
dc.date.issued2018-
dc.identifier.citationJournal of Digestive Diseases, 2018, v. 19 n. 6, p. 369-376-
dc.identifier.issn1751-2972-
dc.identifier.urihttp://hdl.handle.net/10722/256352-
dc.description.abstractOBJECTIVE: Post‐endoscopic sphincterotomy (EST) bleeding is one of the most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP). Although the use of proton pump inhibitors (PPIs) reduces the risk of peptic ulcer bleeding, their role in preventing EST bleeding has not been evaluated. This study aimed to assess the use of pre‐emptive PPIs in patients undergoing EST. METHODS: This was an investigator‐initiated, open‐label, randomized study. Consecutive patients scheduled to undergo ERCP and EST were enrolled after excluding those who had previous EST or used acid‐suppression agents. Eligible patients were randomized to receive either PPI or standard care. The PPI group received intravenous esomeprazole 4 h before the EST and then every 12 h for 1 day, followed by high‐dose oral esomeprazole for 10 days. All patients were followed up for 30 days. The primary outcome was the proportion of patients with combined immediate and delayed overt post‐EST bleeding. RESULTS: Altogether 125 patients (60 in the PPI arm and 65 in the standard care arm) who had undergone EST were analyzed. Immediate bleeding was noted in nine (15.0%) patients in the PPI group and four (6.2%) in the standard care group (P = 0.14). Overt delayed post‐EST bleeding was seen in two (3.3%) and five (7.7%) patients in PPI and standard care arms, respectively (P = 0.44). There were no significant differences in other outcomes, including a decrease in hemoglobin of >20 g/L, the need for blood transfusion, length of hospital stay and 30‐day mortality. CONCLUSION: Pre‐emptive PPI did not reduce the risk of post‐EST bleeding.-
dc.languageeng-
dc.publisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1751-2980-
dc.relation.ispartofJournal of Digestive Diseases-
dc.rightsThis is the peer reviewed version of the article: Journal of Digestive Diseases, 2018, v. 19, n. 6, p. 369-376, which has been published in final form at http://dx.doi.org/10.1111/1751-2980.12604. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.subjectEndoscopic retrograde cholangiopancreatography-
dc.subjectEndoscopic sphicterotomy-
dc.subjectEsomeprazole-
dc.subjectGastrointestinal hemorrhage-
dc.subjectPapillotomy-
dc.titlePrevention of post-sphincterotomy bleeding by proton pump inhibitor: A randomized controlled trial-
dc.typeArticle-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.emailBut, YKD: drdbut@hku.hk-
dc.identifier.emailWong, SY: ksywong@hkucc.hku.hk-
dc.identifier.emailTong, SM: tongsma@hkucc.hku.hk-
dc.identifier.emailLiu, SHK: drkliu@hku.hk-
dc.identifier.emailCheung, KSM: cks634@hku.hk-
dc.identifier.emailChok, KSH: chok6275@hku.hk-
dc.identifier.emailPoon, RTP: poontp@hku.hk-
dc.identifier.emailHung, FNI: ivanhung@hkucc.hku.hk-
dc.identifier.authorityLeung, WK=rp01479-
dc.identifier.authorityCheung, KSM=rp02532-
dc.identifier.authorityChok, KSH=rp02110-
dc.identifier.authorityPoon, RTP=rp00446-
dc.identifier.authorityHung, FNI=rp00508-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/1751-2980.12604-
dc.identifier.pmid29722146-
dc.identifier.scopuseid_2-s2.0-85047624520-
dc.identifier.hkuros286025-
dc.identifier.volume19-
dc.identifier.issue6-
dc.identifier.spage369-
dc.identifier.epage376-
dc.identifier.isiWOS:000437285900006-
dc.publisher.placeAustralia-

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