# Factors associated with delayed bleeding following ampullectomy: A retrospective cohort study

## TL;DR

This study identifies factors that increase the risk of delayed bleeding after ampullectomy, a procedure used to treat certain digestive tract lesions.

## Contribution

The study provides new insights into specific risk factors for delayed bleeding following ampullectomy.

## Key findings

- High-grade dysplasia or intramucosal cancer increases the risk of delayed bleeding.
- Female sex and larger lesion size are associated with higher bleeding risk.
- Procedure duration and elevated international normalized ratio also predict delayed bleeding.

## Abstract

Endoscopic ampullectomy is the preferred treatment for selected periampullary lesions, yet up to 10.6% of patients may experience delayed bleeding post‐procedure. This study aims to identify predictors for bleeding, which remain poorly understood.

This was a single‐center retrospective cohort study of adult patients who underwent endoscopic ampullectomy (EA) between January 2011 and September 2023. The primary outcome was the risk factors for delayed bleeding, defined as post‐procedural bleeding that necessitated either an emergency department visit, hospital admission, blood transfusion, or re‐intervention. Secondary outcomes included adverse events, such as perforation and pancreatitis.

A total of 113 patients underwent EA, and 25 (22.1%) experienced delayed bleeding. Of these, 20 (80%) required repeat endoscopy, six (24%) needed blood transfusions, and three (12%) were managed conservatively. Multivariable logistic regression analysis identified international normalized ratio ≥1.2 (odds ratio [OR] 3.32, 95% confidence interval [95% CI] 1.03–10.74, p = 0.05), presence of high‐grade dysplasia or intramucosal cancer (OR 3.76, 95% CI 1.20–11.81, p = 0.03), female sex (OR 3.14, 95% CI 1.11–8.93, p = 0.03), size of lesion (OR 1.04, 95% CI 1.01–1.08, p = 0.03) and procedure duration (OR 0.98, 95% CI 0.97–0.99, p = 0.04) as independent predictors of delayed bleeding.

Several factors, including features of high‐grade dysplasia‐intramucosal cancer, international normalized ratio ≥1.2, female sex, lesion size, and procedure duration are associated with delayed post‐ampullectomy bleeding. These factors should be taken into consideration when strategizing the reduction of post‐ampullectomy bleeding.