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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events
Harmeet Singh Mashiana, Amaninder Singh Dhaliwal, Harlan Sayles, Banreet Dhindsa, Ji Won Yoo, Qing Wu, Shailender Singh, Ali A Siddiqui, Gordon Ohning, Mohit Girotra, Douglas G Adler
Harmeet Singh Mashiana, Banreet Dhindsa, Ji Won Yoo, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
Amaninder Singh Dhaliwal, Shailender Singh, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
Harlan Sayles, Department of Biostatistics, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
Qing Wu, Nevada Institute of Personalized Medicine, Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV 89154-4009, United States
Ali A Siddiqui, Division of Gastroenterology, Jefferson Medical College, Philadelphia, PA 19107, United States
Gordon Ohning, Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
Mohit Girotra, Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Douglas G Adler, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT 84132, United States
Author contributions: Mashiana HS contributes to literature search, quality assessment, data collection, manuscript preparation; Dhaliwal AS contributes to literature search, data collection; Sayles H is the statistician; Banreet Dhindsa B contributes to data collection, manuscript preparation, and final edit of the manuscript; Yoo JW contributes to manuscript preparation and biostatistics; Wu Q, Singh S, Siddiqui AA, Ohning G, and Girotra M contributes to manuscript preparation and final editing; and Adler DG contributes to preparation and final edit of the manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Douglas G Adler, MD, FACG, AGAF, FASGE, Professor, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, 30 N 1900 E, Room 4R118, Salt Lake City, UT 84132, United States. douglas.adler@hsc.utah.edu
Telephone: +1-801-5817878 Fax: +1-801-5818007
Received: February 28, 2018
Peer-review started: February 28, 2018
First decision: July 9, 2018
Revised: July 17, 2018
Accepted: August 21, 2018
Article in press: August 21, 2018
Published online: November 16, 2018
ARTICLE HIGHLIGHTS
Research background
Patients with cirrhosis undergoing endoscopic retrograde cholangiopancreatography (ERCP) are believed to have increased risks. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events.
Research motivation
ERCP is one of the most commonly performed endoscopic procedures and is known for its high-risk nature. Performing ERCP in patients with cirrhosis is not only challenging, but may even be a high-risk endeavor in this setting. There was therefore a need for a meta-analysis to estimate adverse events associated with ERCP in cirrhosis patients.
Research objectives
To assess the adverse events associated with ERCP in cirrhosis patients.
Research methods
The preferred reporting items for systematic reviews and meta-analyses statement and the meta-analysis of observational studies in epidemiology guidelines were followed. The overall proportion of patients experiencing any post-procedure adverse events or experiencing specific complications were estimated using random effects methods designed for the pooling of proportions. The actual proportions were estimated after the Freeman-Tukey double arcsine transformation had been applied to the individual study proportions and standard errors were calculated using the scoring method.
Research results
Individual adverse events included hemorrhage in 4.58% (95%CI: 2.77-6.75%, I2 = 85.9%), post-ERCP pancreatitis (PEP) in 3.68% (95%CI: 1.83-6.00%, I2 = 89.5%), cholangitis in 1.93% (95%CI: 0.63-3.71%, I2 = 87.1%) and perforation in 0.00% (95%CI: 0.00-0.23%, I2 = 37.8%).
Research conclusions
There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP.
Research perspectives
In the future, a thorough risk/benefit assessment should be performed in cirrhosis patients prior to ERCP.
