The Incidence of Endoscopic Retrograde Cholangiopancreatography-Related Complications in Patients With Liver Transplant: A Meta-Analysis and Systematic Review

Abstract

Background: Existing literature on post-endoscopic retrograde cholangiopancreatography (ERCP) complications in patients with liver transplant remains scarce and largely inconsistent. We therefore aimed to systematically review and analyze the literature on complication rates associated with ERCP in patients with liver transplant. Methods:We performed a comprehensive literature search in Pub-Med, PubMed Central, Embase, and ScienceDirect databases from inception through March 2020 to identify all the studies that evaluated post-ERCP complications in patients with liver transplant. Effect estimates from the individual studies were extracted and combined using the random effect, generic inverse variance method of DerSimonian and Laird, and a pooled odds ratio (OR) and event rates were calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques.Results: Fourteen studies with a total of 1,787 patients were analyzed. In total, 3,192 ERCPs were performed on these patients. The pooled all-complication rate was 5.2% (95% confidence interval (CI): 0.035 -0.075). Procedural complications analyzed included post-ERCP pancreatitis 3.4% (95% CI: 0.025 -0.047), bleeding 1.1% (95% CI: 0.006 -0.020), infections 0.2% (95% CI: 0.025 -0.047), and cholangitis 0.8% (95% CI: 0.004 -0.020). No cases of periprocedural death were reported. The pooled OR for post-ERCP pancreatitis in patients with liver transplant compared to patients without liver transplant was 1.289 (95% CI: 0.455 -3.653, P = 0.633, I 2 = 72.88%). Conclusion:Post-ERCP complication rates in liver transplant patients are comparable to the general population and hence, peri-procedural evaluation and management may follow the current standards of care in this patient population.

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study

“…Within our study, 16.1% of cases exhibited infections after ERCP, defined by the presence of fever and an increase in CRP levels leading to antibiotic therapy. Notably, this infection rate appears higher compared to other studies [5,19,23], which have reported infection rates ranging from 0.2% to 5% in liver transplant patients after ERCP. It is essential to acknowledge that the definition of infection after ERCP in the existing literature is highly inconsistent, limiting comparability in this domain.…”

Applicability of Child-Turcotte-Pugh Score in Anticipating Post-ERCP Adverse Events in Patients With Cirrhosis

“…A recent metaanalysis demonstrated that the pooled prevalence of bleeding, pancreatitis, and cholangitis among patients with cirrhosis undergoing ERCP was 5.1%, 3.02%, and 0.12%. 17 Similarly, Tarar et al 18 demonstrated that the risk of post-ERCP bleeding and pancreatitis, but not cholangitis, are significantly higher among patients with cirrhosis compared with non-cirrhotic counterparts.…”

Risks of Post‐Endoscopic Retrograde Cholangiopancreatography Pancreatitis After Liver Transplantation

“…Unfortunately, ERCPs are not without risks, with post-ERCP pancreatitis (PEP) as the most feared complication. A recent systematic review and meta-analysis has reported an incidence of PEP among LT recipients of 3.4% [10].…”

“…Unfortunately, ERCPs are not without risks, with post‐ERCP pancreatitis (PEP) as the most feared complication. A recent systematic review and meta‐analysis has reported an incidence of PEP among LT recipients of 3.4% [10]. Less common complications after ERCP are postsphincterotomy hemorrhage and cholangitis, which occur in 1.1% and 0.8% of LT recipients, respectively [10].…”

“…A recent systematic review and meta‐analysis has reported an incidence of PEP among LT recipients of 3.4% [10]. Less common complications after ERCP are postsphincterotomy hemorrhage and cholangitis, which occur in 1.1% and 0.8% of LT recipients, respectively [10]. Furthermore, a rare but potential complication after ERCP is a perforation of the intestinal wall [11].…”