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Medline ® Abstract for Reference 34

of 'Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding'

Routine coagulation screening is an unnecessary step prior to ERCP in patients without biochemical evidence of jaundice: a cross-centre study.
Egan RJ, Nicholls J, Walker S, Mellor K, Young WT, Stechman MJ
Int J Surg. 2014 Nov;12(11):1216-20.
INTRODUCTION: Guidelines suggest that all patients with choledocholithiasis should have a coagulation screen prior to endoscopic retrograde cholangiopancreatography (ERCP). This study aims to establish the incidence of deranged coagulation in such patients and its relationship with bleeding complications.
METHODS: Analysis of consecutive patients undergoing ERCP procedures at two NHS sites was undertaken. Exclusion criteria were anti-coagulation use, bleeding disorders or incomplete data. Demographic data, pre-procedure bilirubin and prothrombin time (PT), ERCP procedural information, and bleeding complications were recorded for each. The cohort was divided into jaundice and non-jaundiced groups. Statistical analysis was performed using the student's t-test, Chi-squared test and Fisher's exact test.
RESULTS: 793 patients (419 jaundiced; 374 non-jaundiced) were included. PT was significantly higher in the jaundiced group (greater by 2 (1.35-2.64) seconds; p<0.001). PT was prolonged in 26.7 per cent of the jaundiced group; 28 patients (6.7per cent) had a PT of>16.8 s 5.9 per cent of the non-jaundiced group had prolonged PT, with 1 patient having a PT>16.8 s. There were 5 major, and 32 minor bleeding complications with no differences between groups. In those with abnormal coagulation, only 1 minor bleeding complication occurred in a jaundiced patient.
DISCUSSION: Normal pre-ERCP bilirubin was 99.7% (98.5-100) sensitive to predict a PT<16.8 s. Cost savings of£14,350 could have been achieved with judicial use of coagulation screening.
CONCLUSION: Pre-ERCP coagulation screening should only be indicated in patients with a raised bilirubin or individuals on anticoagulation therapy or with a history of bleeding diathesis.
Department of General Surgery, University Hospital of Wales, Cardiff, Wales CF14 4XW, UK. richardjohnegan@hotmail.com