Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events

Table 3 Endoscopic retrograde cholangiopancreatography-related adverse events in cirrhosis patients

Ref.	Total no. of patients (cirrhotics)	Number of ERCPs	PEP	Hemorrhage	Cholangitis	Perforation	% of complications
Navaneethan et al[5]	3228	3228	3871	681	10	6	14.5
Jagtap et al[20]	134	134	21	41	10	0	11.9
Adler et al[16]	328	538	251	61	15	2	14.6
Inamdar et al[13]	1930	1930	1601	441	15	N/A	11.3
Gill et al[14]	100	100	31	61	3	0	12
Churrango et al[24]	194	194	31	51	N/A	0	4.1
Leal et al[19]	158	158	71	91	10	1	17
Zhang et al[2]	77	77	42	242	1	0	37.6
Li et al[17]	46	46	43	23	3	0	19.5
Ma et al[22]	41	41	04	24	0	0	4.8
Artifon et al[21]	105	105	35	75	0	5	14.2
Park et al[18]	41	41	36	66	4	0	31.7
Prat et al[25]	52	52	01	31	3	1	13.4
Freeman et al[23]	64	64	N/A1	51	N/A	N/A	7.8
Sugiyama et al[15]	H/B	7	0*	0*	0	0	0

¹PEP and bleeding definitions not clear. Most authors used standard accepted criteria for both;

²PEP: typical pancreatic pain without perforation and the level of amylase increased to ≥ 3 ULN after the procedure. Bleeding: hematemesis and/or melena, level of postoperative hemoglobin decreased by > 2 g/dL, or requirement of transfusion therapy;

³PEP: (1) new or worsened abdominal pain; (2) new or prolongation of hospitalization for at least 2 d; and (3) serum amylase ≥ 3 ULN, measured more than 24 h after the procedure. Bleeding: melena and/or hematemesis;

⁴PEP: Symptoms + Amylase > 500. Bleeding same as ²;

⁵PEP: (1) New or worse typical pain (epigastric radiating to the back) associated with tenderness to palpation; (2) Elevation of serum amylase or lipase ≥ 3 ULN; (3) Both (1) and (2) persist for 24 h after the ERCP. Bleeding: Not adequately defined;

⁶PEP: Amylase ≥ 3 ULN the morning after procedure + Symptoms. Bleeding: presence of clinical (not just endoscopic) evidence of bleeding, such as melena or hematemesis, with an associated decrease of at least 2 g/dL in the Hb concentration, or the need for a blood transfusion. ERCP: Endoscopic retrograde cholangiopancreatography; PEP: Post-ERCP pancreatitis; N/A: Not available.