Reducing Post-Endoscopic Sphincterotomy Bleeding: Risk Factor Assessment and Preventive Management

Endoscopic sphincterotomy (EST) is a cornerstone technique for the diagnosis and treatment of pancreatobiliary diseases. However, post-EST bleeding remains a significant adverse event, with a reported incidence of 0.76% to 2%. The management of post-EST bleeding has become increasingly challenging due to the aging population and the widespread use of antithrombotic agents, including antiplatelets, warfarin, and direct oral anticoagulants. Furthermore, the rising number of patients with comorbidities such as liver cirrhosis and end-stage renal disease necessitates more complex decision-making. This review provides a comprehensive overview of pathophysiology, standardized severity classification, and risk factors associated with post-EST bleeding.