{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:47:32Z","timestamp":1753868852820,"version":"3.41.2"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction and objectives<\/jats:title><jats:p>Endoscopic ampullectomy is the preferred treatment for selected periampullary lesions, yet up to 10.6% of patients may experience delayed bleeding post\u2010procedure. This study aims to identify predictors for bleeding, which remain poorly understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center retrospective cohort study of adult patients who underwent endoscopic ampullectomy (EA) between January 2011 and September 2023. The primary outcome was the risk factors for delayed bleeding, defined as post\u2010procedural bleeding that necessitated either an emergency department visit, hospital admission, blood transfusion, or re\u2010intervention. Secondary outcomes included adverse events, such as perforation and pancreatitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 113 patients underwent EA, and 25 (22.1%) experienced delayed bleeding. Of these, 20 (80%) required repeat endoscopy, six (24%) needed blood transfusions, and three (12%) were managed conservatively. Multivariable logistic regression analysis identified international normalized ratio\u00a0\u22651.2 (odds ratio [OR] 3.32, 95% confidence interval [95% CI] 1.03\u201310.74, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.05), presence of high\u2010grade dysplasia or intramucosal cancer (OR 3.76, 95% CI 1.20\u201311.81, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03), female sex (OR 3.14, 95% CI 1.11\u20138.93, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03), size of lesion (OR 1.04, 95% CI 1.01\u20131.08, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03) and procedure duration (OR 0.98, 95% CI 0.97\u20130.99, <jats:italic>p<\/jats:italic> = 0.04) as independent predictors of delayed bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Several factors, including features of high\u2010grade dysplasia\u2010intramucosal cancer, international normalized ratio \u22651.2, female sex, lesion size, and procedure duration are associated with delayed post\u2010ampullectomy bleeding. These factors should be taken into consideration when strategizing the reduction of post\u2010ampullectomy bleeding.<\/jats:p><\/jats:sec>","DOI":"10.1002\/deo2.70078","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T15:43:46Z","timestamp":1739547826000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with delayed bleeding following ampullectomy: A retrospective cohort study"],"prefix":"10.1002","volume":"5","author":[{"given":"Katarzyna M.","family":"Pawlak","sequence":"first","affiliation":[{"name":"Division of Gastroenterology St. Michael's Hospital, University of Toronto  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-7533","authenticated-orcid":false,"given":"Kareem","family":"Khalaf","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology St. Michael's Hospital, 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