Browsing by Author "Bishay, Kirles"

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    Incidence and Risk Factors Associated with Endoscopic Retrograde Cholangiopancreatography-Related Bleeding
    (2022-06) Bishay, Kirles; Forbes, Nauzer; Heitman, Steven; Hilsden, Robert; Bridges, Ron
    Endoscopic retrograde cholangiopancreatography (ERCP) is the cornerstone of therapy for an array of pancreaticobiliary disorders. While highly effective, ERCP-related bleeding is a possible adverse event with an estimated incidence of 2% which can lead to substantial morbidity and mortality. This thesis reports the results of two studies performed with the aim of evaluating the incidence of and risk factors associated with the development of ERCP-related bleeding. Our meta-analysis of observational and randomized trials showed that while the contemporary incidence of bleeding is in keeping with historical estimates, bleeding risk varies considerably within several important patient- and procedure-related subgroups. We then demonstrated via a multicenter prospective cohort study the risk factors associated with both intraprocedural and clinically significant delayed ERCP-related bleeding. We demonstrated that patient sex, kidney disease, papilla morphology, antithrombotic use and procedural techniques contribute to bleeding risk after adjusting for important covariates. Together, these findings demonstrate that bleeding risk in ERCP varies substantially depending on several factors. Clinicians performing ERCP can use our findings to accurately assess bleeding risk permitting tailored risk mitigation management amongst individuals at high risk and to communicate accurate bleeding risk estimates to patients for conferral of informed consent.