Is It Safe to Perform Endoscopic Retrograde Cholangiopancreatography in Decompensated Cirrhosis?

Jagtap, Nitin; Nabi, Zaheer; Tandan, Manu; Ramchandani, Mohan; Sharma, Mithun; Lakhtakia, Sundeep; Rao, Padaki Nagaraja; Gupta, Rajesh; Kalapala, Rakesh; Basha, Jahangeer; Darishetty, Santosh; Rao, Guduru Venkat; Reddy, D. Nageshwar

doi:10.1016/j.jceh.2019.01.006

Cited by 15 publications

(17 citation statements)

References 18 publications

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“…Adler et al reported that patients with Child-Pugh class C had a higher risk of PEP than others [21]. However, whether or not the risk of PEP in patients with liver cirrhosis is high is controversial [22,23]. In our study, although there were no cases of post-ERCP pancreatitis, the number of patients was small, so a larger prospective trial is required to resolve this issue.…”

Section: Discussionmentioning

confidence: 58%

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

et al. 2021

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Background Only a few reports have assessed the effectiveness of endoscopic biliary drainage (EBD) in hepatocellular carcinoma (HCC) patients with obstructive jaundice and liver dysfunction. Methods This was a retrospective study based on the clinical databases from the Okayama University Hospital and 10 affiliated hospitals. All patients received EBD for jaundice or liver dysfunction. The indication for EBD was aggravation of jaundice or liver dysfunction with intrahepatic bile duct (IHBD) dilation. The technical and clinical success rate, complications, factors associated with clinical failure, and survival duration were evaluated. Results A total of 107 patients were enrolled in this study. Technical success was achieved in 105 of 107 patients (98.1%). Clinical success was achieved in 85 of 105 patients (81%). Complications related to endoscopic retrograde cholangiography (ERC) occurred in 3 (2.8%) patients. Child–Pugh class C (odds ratio 3.90, 95% confidence interval [CI] 1.47–10.4, p = 0.0046) was the only factor associated with clinical failure, irrespective of successful drainage. The median survival duration was significantly longer in patients with clinical success than in those without clinical success (5.0 months vs. 0.93 months; hazard ratio [HR] 3.2, 95% CI 1.87–5.37). HCC Stage I/II/III (HR 0.57, CI 0.34–0.95, p = 0.032), absence of portal thrombosis (HR 0.52, CI 0.32–0.85, p = 0.0099), and clinical success (HR 0.39, CI 0.21–0.70, p = 0.0018) were significant factors associated with a long survival. Conclusions EBD for obstructive jaundice and liver dysfunction in patients with HCC can be performed safely with a high technical success rate. Clinical success can improve the survival duration, even in patients expected to have a poor prognosis. Trial registration Retrospectively registered.

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Section: Discussionmentioning

confidence: 58%

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

et al. 2021

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“…For instance, Adler et al [ 8 ] demonstrated that CP class A was associated with a lower risk of ERCP adverse events compared to class B and C combined[ 8 ]. Jagtap et al [ 9 ] found that overall post-ERCP adverse events were increased in patients with CP class C and MELD score > 18[ 9 ]. Li et al [ 10 ] demonstrated that CP class C was associated with a statistically significant higher risk of post-ERCP bleeding, however showed no difference in bleeding between cirrhosis and non-cirrhosis patients[ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis

Bernshteyn¹,

Hu²,

Masood³

et al. 2021

WJH

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BACKGROUND There is minimal objective data regarding adverse events related to endoscopic retrograde cholangio-pancreatography (ERCP) in patients with cirrhosis compared to those without cirrhosis and even fewer data comparing complications among cirrhosis patients based on severity of cirrhosis. AIM To determine if patients with cirrhosis are at increased risk of adverse events related to ERCP: mainly pancreatitis, bleeding, perforation, cholangitis, and mortality; And to see if higher Child-Pugh (CP) score and Model for End-Stage Liver Disease (MELD) score are associated with higher post-ERCP complications. METHODS We performed a retrospective analysis of 692 patients who underwent ERCP and analyzed the impact of cirrhosis etiology, gender, type of sedation used during procedure, interventions performed, and co-morbidities on the rate of complications in cirrhosis patients as compared to non-cirrhosis patients. RESULTS Overall complications were higher in those with cirrhosis as compared to those without cirrhosis ( P = 0.015 at significance level of 0.05). CP class, especially CP class C, was shown to be associated with a significantly higher rate of ERCP complications as compared to CP class A and CP class B ( P = 0.010 at significance level of 0.05). CONCLUSION The results of our study reaffirm that liver cirrhosis has an impact on the occurrence of complications during ERCP. Our study shows that CP class seems to be more reliable as compared to MELD score in predicting complications of ERCP in cirrhosis patients.

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“…It could be further focused on CP class C group in ERCP which had both more bene ts and risks. (Table 5) [7,[11][12][13][14][15][16][17][18][19][20][21][22][23]…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Common Endoscopic Treatments in Patients with Decompensated Liver Cirrhosis

Yang

2021

Preprint

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BackgroundThe safety and efficacy has always been a concern, when patients with decompensated liver cirrhosis (DLC) receive endoscopic treatments. Methods We performed a retrospective study to evaluate the safety and efficacy of common endoscopic treatments including endoscopic resection (ER) and endoscopic retrograde cholangiopancreatography (ERCP) applying to patients with DLC. Results81 patients received ER (43 endoscopic mucosal resection (EMR) and 38 endoscopic submucosal dissection (ESD)) and 131 patients were treated by ERCP. There were no significant differences of the rate of degeneration and invariability of Child-Pugh (CP) class and the overall rate of adverse events between two groups (93.8%/8.6% ER vs. 96.2%/15.3% ERCP). Both the degeneration rate of CP class (35.4%) and the rate of adverse events (27.1%) in subgroup C of ERCP group was significantly higher (P=0). The rate of poor outcomes was higher in ERCP group (12.2%) than that in ER group (2.5%) (P=.02). And subgroup C of ERCP group had a higher poor outcome rate (27.1%) (P=0).ConclusionsER and ERCP could remove focal lesions or relieve symptoms induced by targeted diseases without significant changes of CP class. Significant benefits and risks coexisted in CP class C patients with DLC when receiving ERCP.

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Is It Safe to Perform Endoscopic Retrograde Cholangiopancreatography in Decompensated Cirrhosis?

Cited by 15 publications

References 18 publications

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study

Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis

Safety and Efficacy of Common Endoscopic Treatments in Patients with Decompensated Liver Cirrhosis

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