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

Abstract

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.

Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis

“…The pooled incidence of ERCP-related bleeding in 24 studies 6 , 7 , 10 - 31 was 3.6% (95% CI, 2.8%–4.5%; I 2 =67.5%). The pooled incidence of developing cholangitis reported in 20 studies 6 , 7 , 10 , 11 , 15 - 28 , 30 , 31 was 2.9% (95% CI, 1.9%–3.8%; I 2 =83.4%). Incidence of perforation in 20 studies 6 , 7 , 10 - 12 , 15 - 21 , 23 - 28 , 30 , 31 was 0.3% (95% CI, 0.1%–0.5%; I 2 =3.7%) ( Fig.…”

Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

“…Reports about the adverse events of cirrhotic patients in the English literature are rare. A retrospective study of 692 patients who underwent ERCP revealed that overall complications, including pancreatitis and bleeding, were higher in those with cirrhosis than those without cirrhosis ( p = 0.015) [ 29 ], suggesting that liver cirrhosis is a significant risk factor during a pancreaticobiliary endoscopic procedure. On the other hand, a study of EUS-guided liver biopsy that included 15.8% cirrhotic patients showed that adverse events were uncommon (1.8%), most of which were self-limited [ 30 ].…”

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

“…In contrast, normal serum bilirubin levels have been found to double the risk of postoperative pancreatitis; this deserves further consideration. [ 27 – 29 ]…”

“…In contrast, normal serum bilirubin levels have been found to double the risk of postoperative pancreatitis; this deserves further consideration. [27][28][29] The advantage of our center-Digestive Endoscopic Center, Beijing Friendship Hospital affiliated to Capital Medical University-is that it has a large patient base and the operators have vast experience with ERCP. ERCP is performed at our center in accordance with relevant guidelines [30] and regulations and in accordance with strict operating specifications, especially for patients with cirrhosis.…”

“…More evaluation criteria should be used to assess the severity of cirrhosis to gain a better understanding of the condition of the patients. In contrast, normal serum bilirubin levels have been found to double the risk of postoperative pancreatitis; this deserves further consideration [27–29] …”