Hyperbilirubinemia as a Post-Sphincterotomy Bleeding Risk during Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Procedure in Normal Hemostasis Profile Patients

the development of complications after procedure, such as age, heart and lung condition, electrolyte imbalance, advanced liver disease, and liver coagulopathy. Obstructive jaundice, especially in patients with high bilirubin level can be more challenging due to the risks of infection and bleeding [3, 4]. Hyperbilirubinemia can lead to hemostasis impairment due to poor absorption of vitamin K. Bacterial translocation is also play a major role in hemostasis disturbance due to inflammation, septic complication, and disseminated intravascular coagulation (DIC) [5]. Endoscopic sphincterotomy is a common procedure in ERCP where it has a potential risk for bleeding complication, even in patients with normal blood coagulation [6]. Until now, there is still lack of data about immediate bleeding risk in severe hyperbilirubinemia patients due to post-hepatic obstructive jaundice who underwent ERCP procedure.