A Single Institution's Experience of Infundibulotomy in Patients Taking Antiplatelet Agents: Outcomes, Safety and Complications

Dong Hoon Baek; Geun Am Song; Dong Uk Kim; Gwang Ha Kim; Bong Eun Lee; Hye Kyung Jeon; Joon Hyung Jhi; Jung Ho Bae; Hyun Jeong Lee

doi:10.4166/kjg.2014.63.4.216

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Baek, Song, Kim, Kim, Lee, Jeon, Jhi, Bae, and Lee: A Single Institution's Experience of Infundibulotomy in Patients Taking Antiplatelet Agents: Outcomes, Safety and Complications

Original Article

Korean J Gastroenterol 2014;63(4):216-222.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.4.216

A Single Institution's Experience of Infundibulotomy in Patients Taking Antiplatelet Agents: Outcomes, Safety and Complications

Dong Hoon Baek, Geun Am Song, Dong Uk Kim, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Jung Ho Bae, Hyun Jeong Lee

Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Correspondence to: Geun Am Song, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7869, Fax: +82-51-244-8180, E-mail: gasong@pusan.ac.kr

Received 14 January 2014 Revised 25 February 2014 Accepted 25 February 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The diagnostic and therapeutic utility of endoscopic retrograde cholangiopancreatography (ERCP) has been well demonstrated for biliary and pancreatic diseases. Biliary access can be allowed by infundibulotomy if failed by using the standard cannulation methods. However, no data are available regarding ERCP-related complications in patients taking antiplatelet agents who are undergoing infundibulotomy. Therefore, we aimed to assess the frequency of ERCP-related complications after infundibulotomy in patients taking antiplatelet agents.

Methods

We performed a retrospective study, and enrolled 835 patients who underwent ERCP at Pusan National University Hospital from January 2011 to December 2012. Seventy-two patients had been taking antiplatelet agents prior to the procedure. Patients were classified into two groups according to the utilization of infundibulotomy: 20 patients underwent infundibulotomy (group 1), and 52 patients did not undergo infundibulotomy (group 2). Complications after ERCP were defined as bleeding, post-ERCP pancreatitis, and perforation according to Cotton's criteria.

Results

Between group 1 and 2, there were no significant differences in baseline characteristics. ERCP was successfully performed in all cases. Clinically significant bleeding was observed in one patient in group 1 (5%, 1/20) versus none in group 2. Post-ERCP pancreatitis was observed in 2 patients (10.0%, 2/20) in group 1, and 7 patients (13.5%, 7/52) in group 2 (p=0.691). However, none of these differences were statistically significant. No perforation occurred in both groups.

Conclusions

Considering the low incidence of bleeding after infundibulotomy in patients taking antiplatelet agents, infundibulotomy may be safely performed in this group of patients.

Keywords: Endoscopic retrograde cholangiopancreatography, Antiplatelet agents, Infundibulotomy, Complications

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Table 1.

Baseline Characteristics

	Group 1 (n=20)	Group 2 (n=52)	p-value
Age (yr)	70.9±7.9	71.9±9.4	0.855
Sex (male： female)	10：10	31：21	0.460
Anti-platelet agents			0.605
Aspirin	16 (80.0)	34 (65.4)
Plavix	1 (5.0)	8 (15.4)
Aspirin+plavix	2 (10.0)	7 (13.5)
Cilostazol	1 (5.0)	3 (5.7)
Liver cirrhosis	0	1 (1.9)	0.532
Hemodialysis	0	0	NS
Periampullary diverticulum	4 (20.0)	20 (40.4)	0.104
Disease category			0.307
Cancer	9 (45.0)	14 (26.9)
Stone	10 (50.0)	36 (69.2)
Others^a	1 (5.0)	2 (3.9)
Laboratory finding
Bilirubin (mg/dL)	4.4±5.0	4.3±5.2	0.430
Platelet (×10³/mL)	246.9±74.8	223.7±84.1	0.674
PT (INR)	1.08±0.1	1.07±0.2	0.843
aPTT (sec)	35.2±6.1	36.7±7.6	0.395

Values are presented as mean±SD or n (%).

Group 1, patients underwent infundibulotomy; group 2, patients did not undergo infundibulotomy.

^a Biliary drainage for autoimmune pancreatitis, benign biliary stricture.

Table 2.

Post-ERCP Complication according to the Use of Antiplatelet Agents

	Group 1 (n=20)	Group 2 (n=52)	p-value
Significant hemorrhage	1 (5.0)	0	0.104
Balloon compression or epinephrine injection	2 (10.0)	4 (7.7)	0.751
Pancreatitis	2 (10.0)	7 (13.5)	0.691
Perforation	0	0	NS

Values are presented as n (%).

Group 1, patients underwent infundibulotomy; group 2, patients did not undergo infundibulotomy.

Table 3.

Procedures for Therapeutic ERCP after Biliary Drainage

Procedure	Group 1 (n=16)	Group 2 (n=42)
EST	9 (56.2)	35 (83.3)
EPBD	1 (6.3)	1 (2.4)
Biliary SEMS insertion	6 (37.5)	6 (14.3)
Time to procedure after biliary drainage (day)	7.3	8.8

Values are presented as n (%) or median data.

EST, endoscopic sphincterotomy; EPBD, endoscopic papillary balloon dilatation; SEMS, self-expandable metallic stent.

Group 1, patients underwent infundibulotomy; group 2, patients did not undergo infundibulotomy.

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