BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is treatment modality of choice for management of pancreatobiliary disorders. However, safety of ERCP in the patients with cirrhosis is not adequately studied. This study was aimed to evaluate adverse events in the patients with cirrhosis undergoing ERCP and the predictors of adverse events and mortality. METHODS: The present study was a retrospective analysis of patients with cirrhosis who underwent ERCP from January 2012 to December 2016. Binary logistic regression analysis was performed to ascertain the risk factors for adverse events and mortality at 1 month. RESULTS: A total of 261 patients underwent ERCP (80.8% men, mean age 53.49 ± 12.6years). There were 36 (16.1%) overall adverse events in patients undergoing ERCP for biliary indication, whereas no adverse event in pancreatic indication. On univariate analysis, ascites, encephalopathy, high Child-Pugh-Turcotte (CTP) and model for end-stage liver disease (MELD) score, and creatinine levels were significantly associated; however, on multivariable analysis, CTP class C (p value 0.033; odds ratio [OR] 3.5, 95% confidence interval [CI] 1.1-11.5) and MELD > 18 (p value 0.004; OR 5.6, 95% CI 1.7-17.9) were independent risk factors for adverse events. There were 19 (8.5%) mortalities. On univariate analysis, presence of ascites, encephalopathy, cholangitis, biliary sphincterotomy, high CTP, low albumin, and high creatinine were significantly associated, whereas, on multivariable analysis, presence of cholangitis (p 0.017; OR 3.8, 95% CI 1.3-11.4) was associated increased mortality. CONCLUSION: Although endoscopic sphincterotomy might be safe for the patients with cirrhosis undergoing ERCP; advanced liver cirrhosis may be independent risk factor for post-ERCP adverse events. Cholangitis at admission is an independent risk factor for mortality.
BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is treatment modality of choice for management of pancreatobiliary disorders. However, safety of ERCP in the patients with cirrhosis is not adequately studied. This study was aimed to evaluate adverse events in the patients with cirrhosis undergoing ERCP and the predictors of adverse events and mortality. METHODS: The present study was a retrospective analysis of patients with cirrhosis who underwent ERCP from January 2012 to December 2016. Binary logistic regression analysis was performed to ascertain the risk factors for adverse events and mortality at 1 month. RESULTS: A total of 261 patients underwent ERCP (80.8% men, mean age 53.49 ± 12.6years). There were 36 (16.1%) overall adverse events in patients undergoing ERCP for biliary indication, whereas no adverse event in pancreatic indication. On univariate analysis, ascites, encephalopathy, high Child-Pugh-Turcotte (CTP) and model for end-stage liver disease (MELD) score, and creatinine levels were significantly associated; however, on multivariable analysis, CTP class C (p value 0.033; odds ratio [OR] 3.5, 95% confidence interval [CI] 1.1-11.5) and MELD > 18 (p value 0.004; OR 5.6, 95% CI 1.7-17.9) were independent risk factors for adverse events. There were 19 (8.5%) mortalities. On univariate analysis, presence of ascites, encephalopathy, cholangitis, biliary sphincterotomy, high CTP, low albumin, and high creatinine were significantly associated, whereas, on multivariable analysis, presence of cholangitis (p 0.017; OR 3.8, 95% CI 1.3-11.4) was associated increased mortality. CONCLUSION: Although endoscopic sphincterotomy might be safe for the patients with cirrhosis undergoing ERCP; advanced liver cirrhosis may be independent risk factor for post-ERCP adverse events. Cholangitis at admission is an independent risk factor for mortality.
Authors: Michelle A Anderson; Laurel Fisher; Rajeev Jain; John A Evans; Vasundhara Appalaneni; Tamir Ben-Menachem; Brooks D Cash; G Anton Decker; Dayna S Early; Robert D Fanelli; Deborah A Fisher; Norio Fukami; Joo Ha Hwang; Steven O Ikenberry; Terry L Jue; Khalid M Khan; Mary Lee Krinsky; Phyllis M Malpas; John T Maple; Ravi N Sharaf; Amandeep K Shergill; Jason A Dominitz Journal: Gastrointest Endosc Date: 2012-03 Impact factor: 9.427
Authors: Sumant Inamdar; Tyler M Berzin; Joshua Berkowitz; Divyesh V Sejpal; Mandeep S Sawhney; Ram Chutanni; Douglas K Pleskow; Arvind J Trindade Journal: Liver Int Date: 2016-03-24 Impact factor: 5.828
Authors: Douglas G Adler; Abdul Haseeb; Gloria Francis; C Andrew Kistler; Jeremy Kaplan; Saad S Ghumman; Sobia N Laique; Satish Munigala; Linda Jo Taylor; Kristen Cox; Benjamin Root; Umar Hayat; Ali Siddiqui Journal: Gastrointest Endosc Date: 2015-08-19 Impact factor: 9.427
Authors: M L Freeman; D B Nelson; S Sherman; G B Haber; M E Herman; P J Dorsher; J P Moore; M B Fennerty; M E Ryan; M J Shaw; J D Lande; A M Pheley Journal: N Engl J Med Date: 1996-09-26 Impact factor: 91.245