Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis
10.3349/ymj.2019.60.5.440
- Author:
Ji Yeon KIM
1
;
Hee Seung LEE
;
Moon Jae CHUNG
;
Jeong Youp PARK
;
Seung Woo PARK
;
Si Young SONG
;
Seungmin BANG
Author Information
1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. bang7028@yuhs.ac
- Publication Type:Original Article
- Keywords:
Liver cirrhosis;
endoscopic retrograde cholangiopancreatography;
hemorrhage
- MeSH:
Cholangiopancreatography, Endoscopic Retrograde;
Fibrosis;
Hemorrhage;
Humans;
Incidence;
Liver Cirrhosis;
Liver;
Multivariate Analysis;
Propensity Score;
Prothrombin Time;
Retrospective Studies;
Risk Factors;
Stents
- From:Yonsei Medical Journal
2019;60(5):440-445
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Patients with liver cirrhosis are considered to be at risk for additional adverse events during endoscopic retrograde cholangiopancreatography (ERCP). The present study was designed as a propensity-score matched analysis to investigate whether cirrhotic liver increases the risk of bleeding complications in patients undergoing ERCP. MATERIALS AND METHODS: In total, 8554 patients who underwent ERCP from January 2005 to December 2015 were retrospectively analyzed. To adjust for the imbalance between patients with and those without liver cirrhosis, 1:3 propensity score matching was performed according to age and sex. RESULTS: Liver cirrhosis was identified in 264 (3.1%) patients. After propensity score matching, a total of 768 patients were included in each of the cirrhotic (n=192) and non-cirrhotic groups (n=576). Post-procedure bleeding (10.9% vs. 4.7%, p=0.003) was more frequently observed in patients with liver cirrhosis than in those without. In multivariate analyses, liver cirrhosis was identified as an independent risk factor associated with post-ERCP bleeding (p=0.003) after further adjustment for prothrombin time, antiplatelet/coagulant, duration of ERCP, and stent insertion. Child-Pugh (CP) class C was found to be associated with an increased incidence of post-ERCP bleeding in patients with cirrhosis (odds ratio 6.144, 95% confidence interval 1.320–28.606; p=0.021). CONCLUSION: The incidence of post-ERCP bleeding in patients with liver cirrhosis was higher than that in patients without liver cirrhosis. In particular, CP class C cirrhosis was significantly associated with post-ERCP bleeding.
