Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study.
10.1097/CM9.0000000000002248
- Author:
Jielin LI
1
;
Jiexuan HU
2
;
Peng LI
1
;
Yongdong WU
1
;
Yongjun WANG
1
;
Ming JI
1
;
Haiyang HUA
3
;
Wenbin RAN
4
;
Yanglin PAN
5
;
Shutian ZHANG
1
Author Information
1. Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China.
2. Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
3. Department of Gastroenterology, Cheng De Central Hospital, Chengde, Hebei 067000, China.
4. Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, China.
5. Xijing Hospital of Digestive Diseases, Air Force Medical University of People's Liberation Army, Xi'an, Shaanxi 710032, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Cholangiopancreatography, Endoscopic Retrograde/adverse effects*;
Retrospective Studies;
Constriction, Pathologic;
Risk Factors;
Liver Cirrhosis/complications*;
Pancreatitis/etiology*;
Postoperative Complications/epidemiology*;
Cholangitis
- From:
Chinese Medical Journal
2022;135(19):2319-2325
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy.
METHODS:We performed a multicenter, retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University, Xijing Hospital affiliated to Air Force Military Medical University, Beijing Youan Hospital affiliated to Capital Medical University, and the Fifth Medical Center of the People's Liberation Army General Hospital from June 2003 to August 2019. The adverse events of inpatient ERCP for patients with ( n = 182) and without liver cirrhosis (controls; n = 385) were compared.
RESULTS:A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study. Compared to patients without cirrhosis, patients with cirrhosis were at higher risk for postoperative complications (odds ratio [OR], 4.172; 95% confidence interval [CI], 1.232-7.031; P < 0.001) such as postoperative pancreatitis (OR, 2.026; 95% CI, 1.002-4.378; P = 0.001) and cholangitis (OR, 3.903; 95% CI, 1.001-10.038; P = 0.036). The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis (101 cases; 55.5%), benign bile duct strictures (46 cases; 25.3%), and malignant bile duct strictures (28 cases; 15.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed that the total bilirubin (TBIL) level (OR, 4.58; 95% CI, 2.37-6.70) and Child-Pugh score of C (OR, 3.11; 95% CI, 1.04-5.37) were risk factors for postoperative complications in patients with cirrhosis.
CONCLUSIONS:Compared with the general population of patients undergoing ERCP, patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis. TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.
