Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٣١
defined as the presence of melena, hematochezia, or hematemesis
associated with a hemoglobin decrease of at least 2 g/dL or the need for
blood transfusion (Freeman et al., 1996). The reported incidence of
hemorrhage after sphincterotomy ranges from 0.76% to 2%. In roughly
half of cases this bleeding is delayed (recognition 1 or more days after the
examination) and can occur up to 1 to 2 weeks later. The risk of severe
hemorrhage (i.e., requiring 2 or more units of blood, surgery, or
angiography) is estimated to be 0.1% to 0.5% (Loperfido et al., 1998).
Risk factors for hemorrhage include coagulopathy at the time of the
examination, the use of anticoagulants within 72 hours of the
sphincterotomy, the presence of acute cholangitis or papillary stenosis
and the use of precut sphincterotomy, (Masci et al., 2001).
Ways to prevent hemorrhage:
Bleeding can mostly be avoided by correcting any coagulopathies,
withholding anticoagulant medications for up to 3 days after a
sphincterotomy and the use of alternating coagulating and cutting
diathermy (Qaseem et al., 1996 and Tanaka, 2002).
Catalano et al. (1995) suggested that prophylactic injection of the
sphincterotomy site with epinephrine for endoscopically observed
bleeding, or even a sclerosing agent in patients with coaglopathy, may
reduce the risk of hemorrhage.
ERCP-induced hemorrhage is monitored clinically and with
laboratory tests (Baille, 1998), therefore, intraluminal bleeding is
primarily recognized (Patel and Shaps, 1982). CT is not typically
performed for diagnosis of hemorrhage; however, blood may be detected
if CT is performed for another indication. CT findings of acute duodenal
hemorrhage are duodenal wall thickening and a high-attenuation mass in