In this study, physicians from Greece investigated the risk of bleeding in adult hemophiliac patients undergoing endoscopic sphincterotomy for choledocholithiasis.
The team assessed 7 patients with hemophilia A and 2 with hemophilia B who were referred for endoscopic sphincterotomy, between 1983 and 2002.
The degree of hemophilia varied. It was mild in 4 patients, moderate in 3, and severe in 2. The team found that pre-admission levels of blood clotting factors ranged between <1% and 18%.
|No patients developed bleeding after sphincterotomy.|
The team monitored the levels of deficient factors before and after sphincterotomy. The relevant factor was replaced to achieve 100% activity before, and for 24 hours after, the procedure.
Overall, 7 patients required factor replacement every 8 hours, while 2 patients received continuous infusions.
The team found that none of the patients developed bleeding after sphincterotomy.
They determined that 48 hours after the procedure the patients who had received continuous infusions had a factor level of greater than 90%. The patients who received intermittent factor replacement had levels >50%.
After discharge, the patients were treated with regular infusion of the deficient factor for 15 days.
Dr Panagiotis Katsinelos's team concluded, "Patients with hemophilia can undergo endoscopic sphincterotomy without bleeding complications".