Bleeding after sphincterotomy in liver transplanted patients with biliary complications

OBJECTIVE: To investigate the rate of immediate persistent bleeding requiring haemostasis and of delayed bleeding after endoscopic sphincterotomy in liver transplanted patients. METHODS: Clinical records of patients who underwent endoscopic sphincterotomy at our Center between January 2003 and December 2009 were reviewed. Platelets count, international normalized ratio, aminosalicylic acid use, presence of cholangitis and use of precut were evaluated as risk factors for bleeding. Crude and adjusted risk ratios (RR) with 95% confidence interval were calculated, using Poisson model. RESULTS: Forty-nine liver transplanted patients and 202 controls were studied. Rate of delayed bleeding, but not need of immediate haemostasis, was increased in liver transplanted patients, RRs of 11.0 (3.0-40.0) and 1.5 (0.7-3.4) respectively. The RR of delayed bleeding remained unchanged once adjusted for the other evaluated variables. CONCLUSION: In liver transplanted patients, the risk of bleeding after endoscopic sphincterotomy is markedly increased. Reasons for this increase still need to be elucidated.