Published online Apr 27, 2021. doi: 10.4254/wjh.v13.i4.472
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
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.
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.
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.
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.
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.
Complications are increased in patients with cirrhosis, especially those in CP Class C.
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.