Nelson and Freeman identified a number of risk factors associated with major hemorrhage following endoscopic sphincterotomy. These can help to identify patients who should be monitored for this complication. The authors are from the Minneapolis VA Medical Center and Hennepin County Medical Center in Minneapolis.


Patient selection: endoscopic sphincterotomy of the sphincter of Oddi


Outcome - major hemorrhage which was defined as both of the following:

(1) clinical evidence of bleeding (melena, hematemesis, endoscopically observed bleeding)

(2) one or more of the following: fall in hemoglobin > 3 g/dL over 4 days, need for red blood cell transfusion or need for a subsequent endoscopic intervention to control bleeding.


Risk factors for major hemorrhage:

(1) hemostatic defect as indicated by a prothrombin time >= 2 seconds greater than the control

(2) hemodialysis

(3) bleeding observed during the sphincterotomy


The hemorrhage may occur in association with the sphincterotomy or be delayed.


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