Sumant Inamdar1, Tyler M Berzin2, Joshua Berkowitz2, Divyesh V Sejpal2, Mandeep S Sawhney2, Ram Chutanni2, Douglas K Pleskow2, Arvind J Trindade3. 1. Division of Gastroenterology, Hofsta Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA. 2. The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 3. Division of Gastroenterology, Hofsta Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA. arvind.trindade@gmail.com.
Abstract
BACKGROUND AND AIMS: There are limited data regarding the safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis. The current literature consists of small series totalling less than 225 patients. METHODS: Retrospective matched cohort study of the National Inpatient Sample (NIS) for 2009. We compared adverse events of cirrhotic patients who underwent ERCP (n = 1930) with a matched control group that consisted of randomly selected non-cirrhotic patients who underwent ERCP (n = 5790). An additional control group, to measure cirrhosis-related adverse events, consisted of cirrhotic patients undergoing non-pancreaticobiliary endoscopy. RESULTS: ERCP-associated adverse events of post-ERCP pancreatitis (PEP) (8.3% vs. 5.5%) and bleeding (2.3% vs. 1.0%) were more common in the cirrhosis cohort vs. the non-cirrhosis cohort (all P < 0.05). In subgroup analysis, compensated cirrhotic patients (n = 1308) had a similar adverse event profile to non-cirrhotic controls except for a slightly higher rate of PEP (7.7% vs. 5.5%; P < 0.05). However, decompensated cirrhotic patients (n = 622) had statistically significant higher rates of PEP (9.7% vs. 5.5%) and bleeding (4.3% vs. 1.0%), compared with non-cirrhotic controls respectively (P < 0.05). In regard to cirrhosis-related adverse events, cirrhotic patients undergoing ERCP were more likely to develop bacterial peritonitis vs. cirrhotic patients undergoing non-pancreaticobiliary endoscopy (2.2% vs. 1.1%; P < 0.005). CONCLUSION: ERCP adverse events were statistically higher among patients with decompensated cirrhosis. This increased risk needs to be confirmed with prospective studies. A thorough risk/benefit assessment should be performed prior to performing ERCP in decompensated cirrhotic patients.
BACKGROUND AND AIMS: There are limited data regarding the safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis. The current literature consists of small series totalling less than 225 patients. METHODS: Retrospective matched cohort study of the National Inpatient Sample (NIS) for 2009. We compared adverse events of cirrhotic patients who underwent ERCP (n = 1930) with a matched control group that consisted of randomly selected non-cirrhotic patients who underwent ERCP (n = 5790). An additional control group, to measure cirrhosis-related adverse events, consisted of cirrhotic patients undergoing non-pancreaticobiliary endoscopy. RESULTS: ERCP-associated adverse events of post-ERCP pancreatitis (PEP) (8.3% vs. 5.5%) and bleeding (2.3% vs. 1.0%) were more common in the cirrhosis cohort vs. the non-cirrhosis cohort (all P < 0.05). In subgroup analysis, compensated cirrhotic patients (n = 1308) had a similar adverse event profile to non-cirrhotic controls except for a slightly higher rate of PEP (7.7% vs. 5.5%; P < 0.05). However, decompensated cirrhotic patients (n = 622) had statistically significant higher rates of PEP (9.7% vs. 5.5%) and bleeding (4.3% vs. 1.0%), compared with non-cirrhotic controls respectively (P < 0.05). In regard to cirrhosis-related adverse events, cirrhotic patients undergoing ERCP were more likely to develop bacterial peritonitis vs. cirrhotic patients undergoing non-pancreaticobiliary endoscopy (2.2% vs. 1.1%; P < 0.005). CONCLUSION: ERCP adverse events were statistically higher among patients with decompensated cirrhosis. This increased risk needs to be confirmed with prospective studies. A thorough risk/benefit assessment should be performed prior to performing ERCP in decompensated cirrhotic patients.
Authors: Abimbola Adike; Mohanad Al-Qaisi; Noemi J Baffy; Heidi Kosiorek; Rahul Pannala; Bashar Aqel; Douglas O Faigel; M Edwyn Harrison Journal: Gastroenterology Res Date: 2017-06-30
Authors: Harmeet Singh Mashiana; Amaninder Singh Dhaliwal; Harlan Sayles; Banreet Dhindsa; Ji Won Yoo; Qing Wu; Shailender Singh; Ali A Siddiqui; Gordon Ohning; Mohit Girotra; Douglas G Adler Journal: World J Gastrointest Endosc Date: 2018-11-16
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