B0446 - Pre-Procedure Desmopressin and Bleeding Risk After Endoscopic Retrograde Cholangiopancreatography and Endoscopic Biliary Sphincterotomy

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

BD

Brenton Davis, MD

UCSF Medical Center
San Francisco, CA

Brenton Davis, MD¹, Alexis Bayudan, MD¹, Alec Faggen, MD¹, Hyun Ji, MD², Ruzbeh Mosadeghi, MD¹, Faisal Kamal, MD¹, Sun-Chuan Dai, MD¹, Patrick Avila, MD¹, Craig Monroe, MD¹, Abdul Kouanda, MD¹
¹UCSF Medical Center, San Francisco, CA; ²University of California San Francisco, San Francisco, CA

Introduction: Intravenous Desmopressin (DDAVP) is sometimes given to uremic patients before endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy to reduce the risk post-sphincterotomy bleeding. However, this is based on extrapolation from previous studies that evaluated the use of desmopressin prior to surgery or renal biopsy to decrease the risk of bleeding and transfusion requirements. The aim of this study was to identify the impact of desmopressin on post-sphincterotomy bleeding rates after ERCP.

Methods: We performed a single-center retrospective study of patients who underwent an ERCP with sphincterotomy at our institution between January 2011 and January 2021. Primary outcomes were the rate of post sphincterotomy bleeding (PSB). Descriptive statistics and univariable analysis were performed.

Results: 2500 patients underwent ERCP with sphincterotomy during the study period, 99 (4.0%) of which received DDAVP. Post-sphincterotomy bleeding occurred in 31 patients (1.24%). Patients who experienced PSB had higher BUN (p< .001), were more likely to be on hemodialysis (p=.04) and were more likely to receive DDAVP (p< .001).

Discussion: Post-sphincterotomy bleeding was more likely to occur in patients who received desmopressin. This suggests that desmopressin does not reduce PSB and therefore should not be used for this purpose. Uremia and renal failure are associated with PSB, but desmopressin does not reduce this risk.

Variables	PSB N=31	No PSB N=2469	P-value
Age	58.6±24.0	54.4±20.9	.17
Gender
Female	16 (51.6)	1,405 (56.9)	.55
Pre-op Labs
BUN	22.0±17.4	13.2±10.3	< .001
Cr	1.47±1.4	0.90±0.71	.037
INR	1.2±0.3	1.1±0.2	.26
Platelets	213.0±118.5	240.0±108.8	.12
Anti-platelets
Aspirin	8 (25.8)	541 (21.9)	.60
Clopidogrel	1 (3.2)	32 (1.3)	.35
DAPT	1 (3.2)	17 (.69)	.09
Anticoagulation
Any	1 (3.2)	109 (4.4)	.75
Enoxaparin	0 (0)	25 (1.0)	.50
Warfarin	1 (3.2)	35 (1.4)	.40
Rivaroxaban	0 (0)	29 (1.2)	.54
Apixaban	0 (0)	39 (1.6)	.48
Edoxaban	0 (0)	1 (.04)
Dabigatran	0 (0)	5 (0.2)	.80
DVT Prophylaxis
Subcutaneous Heparin	4 (12.9)	291 (11.8)	.85
Enoxaparin	0 (0)	50 (2.0)	.42
ESRD	3 (9.7)	80 (3.2)	.04
DDAVP	6 (19.4)	93 (3.8)	< .001
Values are reported as n (%) or mean±SD

Table: Patient characteristics comparing patients who had post-sphincterotomy bleed and those who did not

Disclosures:

Brenton Davis indicated no relevant financial relationships.

Alexis Bayudan indicated no relevant financial relationships.

Alec Faggen indicated no relevant financial relationships.

Hyun Ji indicated no relevant financial relationships.

Ruzbeh Mosadeghi indicated no relevant financial relationships.

Faisal Kamal indicated no relevant financial relationships.

Sun-Chuan Dai indicated no relevant financial relationships.

Patrick Avila indicated no relevant financial relationships.

Craig Monroe indicated no relevant financial relationships.

Abdul Kouanda indicated no relevant financial relationships.

Brenton Davis, MD¹, Alexis Bayudan, MD¹, Alec Faggen, MD¹, Hyun Ji, MD², Ruzbeh Mosadeghi, MD¹, Faisal Kamal, MD¹, Sun-Chuan Dai, MD¹, Patrick Avila, MD¹, Craig Monroe, MD¹, Abdul Kouanda, MD¹. B0446 - Pre-Procedure Desmopressin and Bleeding Risk After Endoscopic Retrograde Cholangiopancreatography and Endoscopic Biliary Sphincterotomy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.