Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2021; 13(4): 472-482
Published online Apr 27, 2021. doi: 10.4254/wjh.v13.i4.472
Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis
Michelle Bernshteyn, Linda Hu, Umair Masood, Anuj Vikrant Sharma, Danning Huang, Bishnu Sapkota
Michelle Bernshteyn, Linda Hu, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
Umair Masood, Anuj Vikrant Sharma, Division of Gastroenterology and Hepatology, State University of New York Upstate Medical University, Syracuse, NY 13210, United States
Danning Huang, Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
Bishnu Sapkota, Division of Gastroenterology and Hepatology, SUNY Upstate Medical University and Syracuse VA Medical Center, Syracuse, NY 13210, United States
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The SUNY Upstate IRB has determined this project is exempt from Institutional Review Board (IRB) review according to federal regulations.
Informed consent statement: Informed consent was not obtained from the participants as this is a retrospective study with no identifying information. Confirmation was obtained from the journal’s technical support.
Conflict-of-interest statement: There are no conflicts of interest with any of the authors.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Michelle Bernshteyn, MD, Doctor, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13202, United States.
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: February 13, 2021
Revised: March 8, 2021
Accepted: April 7, 2021
Article in press: April 7, 2021
Published online: April 27, 2021
Research background

Endoscopic retrograde cholangio-pancreatography (ERCP) is associated with a risk of adverse events. There remains a scarce amount of data investigating complications associated with ERCP in patients with cirrhosis as compared to patients without cirrhosis.

Research motivation

Our aim was to determine if patients with cirrhosis are at increased risk of complications associated with ERCP and if a higher Child-Pugh (CP) score and Model for End-Stage Liver Disease (MELD) score are linked to higher post-ERCP adverse events. Findings should encourage clinicians to be aware of the increased risk when referring for, or performing, an ERCP on a patient with cirrhosis.

Research objectives

Our primary aim was to determine if patients with an underlying diagnosis of cirrhosis are at elevated risk of complications compared to patients without cirrhosis, specifically pancreatitis, bleeding, perforation, cholangitis, and mortality. Our study takes previous research a step further by investigating the impact of cirrhosis etiology, gender, type of sedation used during procedure, interventions performed, and co-morbidities on the rate of complications of ERCP.

Research methods

This was a retrospective analysis in which a statistical analysis of the complication rates in the groups with and without cirrhosis was performed using a chi-squared test, and fishers exact test when there were < 5 individuals in a category. Odds ratios with 95% confidence intervals were derived from logistic regression as a supportive method in confirming the findings of Child score significance.

Research results

The results of our study reaffirm that liver cirrhosis has an impact on the occurrence of complications during ERCP. Our study demonstrated a statistically significant proportion of cirrhosis patients with CP class A or class B were less likely to develop complications than those in CP class C. Our study demonstrated that MELD score was not reliable in predicting complications.

Research conclusions

Complications are increased in patients with cirrhosis, especially those in CP Class C.

Research perspectives

Further studies, particularly prospective studies, are required to confirm the risk of performing an ERCP on a patient with cirrhosis, and further delineate the relationship between cirrhosis and complication risk during ERCP.