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Medline ® Abstract for Reference 79

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

Refractory bleeding after endoscopic sphincterotomy: a new indication for recombinant factor VII therapy?
Romero-Castro R, Jiménez-Sáenz M, Pellicer-Bautista F, Herrerías-Gutiérrez JM
Am J Gastroenterol. 2004;99(10):2063.
The therapeutic approach in post-ERCP bleeding depends on the severity of the episode. In most instances early bleeding is self-limited, but when it is severe enough endoscopic injection of epinephrine (EP) is the usual treatment. Nevertheless, in some cases bleeding relapses, whereas in between 5% and 10% of patients the refractoriness to endoscopic management may even be fatal and other therapeutic alternatives would be needed. Otherwise, in a small subgroup of cases the bleeding becomes massive, the vision is obscured, and the injection may be very difficult in a situation of hemodynamic instability. We here report a case of refractory post-endoscopic sphincterotomy (ES) bleeding in a patient without preexisting coagulopathy, successfully treated with a single injection of rFVII. This novel experience suggests that rFVIIa, besides its actual high costs, might be useful and safe as a second-line, noninvasive, therapeutic tool in selected cases of massive, or refractory, post-ES bleeding.
Department of Gastroenterology, Virgen Macarena University Hospital, Seville, Spain.