Refractory Bleeding after Endoscopic Sphincterotomy: A New Indication for Recombinant Factor VII Therapy?

Romero-Castro, R.; Jiménez-Sáenz, M.; Pellicer-Bautista, F.; Herrerías-Gutiérrez, J.M.
October 2004
American Journal of Gastroenterology;Oct2004, Vol. 99 Issue 10, p2063
Academic Journal
Case Study
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 unstability. 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.


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