PPI for Prevention of Post-sphincterotomy Bleeding

Prevention of Delayed Post-sphincterotomy Bleeding by High Dose Proton Pump Inhibitor

Endoscopic biliary sphincterotomy is a common and important procedure for biliary access and therapy during endoscopic retrograde cholangiopancreatography (ERCP). Bleeding is one of the important complications related to sphincterotomy. This study determines the role of proton pump inhibitor (PPI) in preventing post-sphincterotomy bleeding in patients undergoing ERCP and sphincterotomy.

Eligible patients will be randomized to receive either high dose PPI or standard care. PPI will be given before ERCP and continue for one week after the sphincterotomy.

Both overt and occult bleeding will be documented up to 10 days after the sphincterotomy. Bleeding rates of the two groups will be compared.

Inclusion Criteria:

• Consecutive patients undergoing ERCP who will require sphincterotomy

Exclusion Criteria:

• Previous sphincterotomy/papillotomy
• Previous Polya gastrectomy
• Patients on maintenance PPI
• Pregnant and lactating women
• Age <18 years
• Previous liver transplant
• unable to consent for study