Endoscopic papillectomy (EP) is an efficacious intervention for the management of papillary adenomas. It may also be considered for carcinoma without S2 invasion and neuroendocrine tumors. However post-papillectomy bleeding (PPB) requiring reintervention is not rare. We aimed to study several parameters to predict post-papillectomy bleeding.

Over a fifteen year period, we performed EP for 132 patients. There were 68 males and 64 females. Median age was 46 (range: 32-76). For resection Endocut Q current (ERBE, VIO 300 S electrosurgical unit with APC; Germany) was used.

Bleeding requiring re-intervention or blood transfusion happened in 14 patients (10 %). In another 7, bleeding manifested with melena and drop in hemoglobin, expectant management was suffice (Total 15.9 %). Bleeding manifested with a median time of 12 hours (1-42). Management by re-intervention included; clips, argon plasma coagulation (APC), ancaferd spray, and metallic stent inserion into common bile duct. None required surgery, death did not happen. We compared these 21 against 111 who did not bleed in reference to age, gender, coagulation parameters, use of anti-platelet or anti-coagulant agents (that were stopped before a certain time of the procedure), size and histology of the resected papilla, administration of APC after papillectomy and no significant difference was found. In five of 21 patients (23 %), bleeding happened after 24 hours and all had been discharged before bleeding manifested.

Bleeding after EP seems to be an unpredictable event. However keeping the patients in-hospital and withholding antiplatelet and anticoagulant agents for 48 hours after procedure, if possible, may be a safer.