Successful endoscopic sphincterotomy for choledocholithiasis in a patient with severe hemophilia A and inhibitors |
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Authors: | Ryo Sugiura Masaki Kuwatani Kazumichi Kawakubo Itsuki Sano Shin Kato Tomoyuki Endo Naoya Sakamoto |
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Institution: | 1.Department of Gastroenterology and Hepatology,Hokkaido University Faculty of Medicine and Graduate School of Medicine,Sapporo,Japan;2.Division of Endoscopy,Hokkaido University Hospital,Sapporo,Japan;3.Department of Hematology,Hokkaido University Graduate School of Medicine,Sapporo,Japan |
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Abstract: | Endoscopic sphincterotomy (ES) is a standard procedure for bile duct stone removal. However, the safety of ES in patients with hemophilia remains unknown. We treated a 46-year-old man who had choledocholithiasis and severe hemophilia A with high-responding inhibitors during immune tolerance induction therapy. Since coagulation factor VIII inhibitors neutralize and inactivate endogenous and exogenous factor VIII, bleeding risk is higher in hemophilia A patients with inhibitors than in those without inhibitors. With adequate pre- and post-procedure monitoring of the clotting factor and supplemented clotting factor, the patient could safely undergo ES without bleeding complications. ES can be also an effective and safe first-line therapy for choledocholithiasis in patients with hemophilia and inhibitors under the condition of appropriate management. |
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