Octreotide and Delayed Bleeding after Endoscopic Papillectomy: a Propensity Score Matching Analysis

Abstract

Background - Endoscopic papillectomy (EP) is widely used for managing ampullary lesions but carries risks of adverse events like delayed bleeding and pancreatitis. Octreotide has been proposed as a preventive measure for these complications, but its efficacy remains uncertain. Methods - A retrospective cohort study was conducted at University Medical Center Utrecht from 2015 to 2023. Risk factors for adverse events were identified using logistic regression. The impact of octreotide prophylaxis was assessed using propensity score matching. Results - A total of 69 ampullary lesions in 50 patients were resected, achieving complete endoscopic resection in 92% of primary procedures (median lesion size 15mm, IQR 10- 31.5mm). EP-related adverse events occurred in 45% of procedures, with delayed bleeding in 28% of cases. Management included endoscopic hemostasis (n=7) and embolization (n=2). Older age (OR 1.12, 95% CI 1.02-1.23, p=0.014) and lesion size >30mm (OR 7.43, 95% CI 1.12- 49.36, p=0.038) were risk factors for delayed bleeding. Octreotide administration in 19 procedures did not reduce delayed bleeding risk. Pancreatitis (17%) and delayed perforation (7%) resulted in mortality in two patients (4%). Placement of a pancreatic duct stent significantly correlated with lower post-procedural pancreatitis incidence (OR 0.15, 95% CI 0.033-0.71, p=0.017). Tumor recurrence was observed in 38% of patients, and final endoscopic success after repeat EP procedures was achieved in 70% of patients. Conclusion - EP effectively treats ampullary adenomas but poses notable risks, including pancreatitis and delayed bleeding. Octreotide prophylaxis does not significantly reduce delayed bleeding incidence. Further research is necessary to optimize complication prevention.