Management of Common Bile Duct Stones in Cirrhotic Patients with Coagulopathy: A Comparison of Supra-Papillary Puncture and Standard Cannulation Technique

Artifon, Everson L.A.; Silveira, Edilene Aparecida Araújo da; Aparicio, Dayse P.; Takada, Jonas; Baracat, Renato; Sakai, Christiano; Garcia, Ruel T.; Teich, Vanessa; Couto, D

doi:10.1007/s10620-011-1593-2

Cited by 16 publications

(8 citation statements)

References 33 publications

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“…Similarly, increased rates of PEP with EST were seen by Adler et al[ 16 ]. Artifon et al[ 21 ] showed that the risk of PEP was decreased with supra-papillary technique (0%) in comparison with standard cannulation technique (4.8%). Park et al[ 18 ] suggested lower rates of PEP with endoscopic papillary balloon dilation in comparison to EST, but the results did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events

Mashiana

Dhaliwal

Sayles

et al. 2018

WJGE

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AIMTo investigate indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events.METHODSWe performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017.RESULTSA total of 6,505 patients from 15 studies were analyzed (male ratio 59%, mean age 59 years), 11% with alcoholic and 89% with non-alcoholic cirrhosis, with 56.2% Child-Pugh class A, and 43.8% class B or C. Indications for ERCP included choledocholithiasis 60.9%, biliary strictures 26.2%, gallstone pancreatitis 21.1% and cholangitis 15.5%. Types of interventions included endoscopic sphincterotomy 52.7%, biliary stenting 16.7% and biliary dilation 4.6%. Individual adverse events included hemorrhage in 4.58% (95%CI: 2.77-6.75%, I2 = 85.9%), post-ERCP pancreatitis (PEP) in 3.68% (95%CI: 1.83-6.00%, I2 = 89.5%), cholangitis in 1.93% (95%CI: 0.63-3.71%, I2 = 87.1%) and perforation in 0.00% (95%CI: 0.00-0.23%, I2 = 37.8%). Six studies were used for comparison of ERCP-related complications in cirrhosis vs non-cirrhosis, which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63 (95%CI: 1.27-2.09, I2 = 65%): higher rates of hemorrhage with OR of 2.05 (95%CI: 1.62-2.58, I2 = 2.1%) and PEP with OR of 1.33 (95%CI: 1.04-1.70, I2=65%), but similar cholangitis rates with OR of 1.23 (95%CI: 0.67-2.26, I2 = 44.3%).CONCLUSIONThere is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP. A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events

Mashiana

Dhaliwal

Sayles

et al. 2018

WJGE

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“…Often these explorations were not therapeutic as the jaundice was presumably related to the decompensation of chronic liver disease and not obstruction 6,8,18–22 . This type of scenario has become uncommon since the accuracy of imaging 85,86 and efficacy of endoscopic intervention 87,88 have improved and percutaneous biliary interventions have become available 83,89,90 . More generally, the death rate from chronic liver disease has changed substantially coincident with the introduction of LC 91,92 .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

Laurence

Tran

Richardson

et al. 2012

HPB

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“…In recent years several studies on ERCP in liver cirrhosis have been conducted . A major pitfall of these studies is that they defined decompensation or progression of liver cirrhosis using the Child–Turcotte–Pugh classification, which might have been biased by obstructive jaundice and acute inflammatory conditions.…”

Section: Discussionmentioning

confidence: 99%

Outcome of endoscopic retrograde cholangiopancreatography in patients with clinically defined decompensated liver cirrhosis

Lee

Kim

et al. 2018

J of Digest Diseases

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Management of Common Bile Duct Stones in Cirrhotic Patients with Coagulopathy: A Comparison of Supra-Papillary Puncture and Standard Cannulation Technique

Cited by 16 publications

References 33 publications

Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events

Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events

Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

Outcome of endoscopic retrograde cholangiopancreatography in patients with clinically defined decompensated liver cirrhosis

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