Post‐Endoscopic Retrograde Cholangiopancreatography Bleeding After Endoscopic Stone Removal in Dialysis Patients: A Multicenter Retrospective Study

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Objectives: Post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding occurs more frequently in dialysis patients than in non-dialysis patients. This study aimed to identify risk factors for post-ERCP bleeding following stone removal in patients undergoing dialysis. Methods: This multicenter retrospective study enrolled 102 consecutive dialysis patients who underwent endoscopic stone removal at seven institutions between January 2009 and March 2022. Baseline characteristics, procedural details, stone removal outcomes, adverse events (AEs), and risk factors for post-ERCP bleeding were analyzed. Results: Of the 102 patients, 65 were men. Median patient age was 77 years (range, 51-91 years). Antithrombotic drugs were administered to 64 patients (63%). Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and endoscopic papillary large balloon dilation were performed in 58 (57%), 20 (20%), and 11 (11%) patients, respectively. AEs occurred in 23 patients (23%), including bleeding in eight patients (8%), acute pancreatitis in nine patients (9%), cholangitis in seven patients (7%), and others in two patients (2%). Multivariate analysis identified intraoperative bleeding and continued aspirin use as independent risk factors for post-ERCP bleeding. Similar associations were observed in subgroup analyses restricted to patients with a naïve papilla. Conclusions: Intraoperative bleeding and continued aspirin use were associated with post-ERCP bleeding following stone removal in dialysis patients, highlighting the importance of careful periprocedural hemostatic management in this population. Trial Registration: Not applicable.

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