Risk factors associated with complications in cirrhotic patients undergoing endoscopic retrograde cholangio-pancreatography

Macías-Rodríguez, Ricardo Ulises; Ruiz-Margáin, Astrid; Rodríguez-García, J L; Zepeda-Gómez, Sergio; Torre, Aldo

doi:10.1097/meg.0000000000000768

Cited by 12 publications

(15 citation statements)

References 23 publications

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“…8,9 Subgroup analysis showed an increased risk of adverse events only in patients with decompensated cirrhosis. 8,9 Nevertheless, another two studies showed increased overall adverse events in cirrhotic patients compared with noncirrhotic patients. 10,12 Therefore, the risk of an adverse event in patients with cirrhosis is controversial.…”

Section: Discussionmentioning

confidence: 98%

“…12 Again, details of EV, including the case number of patients with EV and high-risk EV, were not revealed in previous studies. [8][9][10][11][12] We found no esophageal variceal bleeding during and after diagnostic or therapeutic ERCP, even in those with high-risk EV. Interestingly, one patient with concomitant gastro-EV experienced gastric variceal bleeding 2 days after the procedure.…”

Section: Discussionmentioning

confidence: 99%

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The risk of variceal bleeding during endoscopic retrograde cholangiopancreatography

Yang

Chang

et al. 2022

Journal of the Chinese Medical Association

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely performed procedure. However, the risk of variceal bleeding during ERCP has rarely been assessed. This study aims to evaluate the risk of variceal bleeding in patients with esophageal varices (EV) undergoing ERCP. Methods: From October 2010 to November 2017, the study retrospectively enrolled 75 cirrhotic patients who received elective ERCP. The patient's risk of gastrointestinal (GI) and variceal bleeding and other procedure-related adverse events within 30 days of ERCP were evaluated. Results: Among the 75 patients, 45 patients (60.0%) had EV. Most of the patients were males (65.3%), and there were high rates of viral hepatitis B-related cirrhosis (36.0%), Child-Pugh B (49.3%), and an indication of choledocholithiasis (40.0%). Thirty-three of 45 (73.3%) patients had high-risk EV, and nine (20.0%) patients had concomitant gastric varices. There was no esophageal variceal bleeding; however, one patient had gastric variceal bleeding after ERCP. Nonvariceal significant GI bleeding occurred in three patients with EV and one without EV (p = 0.529). Post-ERCP pancreatitis occurred in three patients with EV and five without EV (p = 0.169). No perforation or procedure-associated mortality was noted. Conclusion:The risk of esophageal variceal bleeding within 30 days of ERCP is neglectable, except for a patient who suffered from gastric variceal bleeding. Other complications, such as nonvariceal bleeding and pancreatitis, are also no higher in patients with EV. Therefore, ERCP is generally a safe procedure for a patient with high-risk esophageal varices.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The risk of variceal bleeding during endoscopic retrograde cholangiopancreatography

Yang

Chang

et al. 2022

Journal of the Chinese Medical Association

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“…These studies consistently showed that patients with higher CP scores had more complications overall. [22][23][24][25] Li et al [8] reported 46 cases of choledocholithiasis treated with ERCP in patients with cirrhosis and found that the incidence of clinically significant bleeding after ERCP was very high (25%) for patients with CP score C. Another study found that the amount of blood loss for patients with cirrhosis and CP score C was significantly higher than that for those with CP score A or B. [26] Patients with cirrhosis may develop varicose veins in the duodenum, which may increase the risk of bleeding after sphincterotomy.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

et al. 2022

Chinese Medical Journal

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy. Methods: We performed a multicenter, retrospective study of all patients at

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“…Cirrhotic patients have a comparable rate of adverse events of ERCP to noncirrhotic patients. [ 34 ] Overall, ERCP can be conducted safely in cirrhotic patients, and the risk of postprocedural bleeding may be improved in large and medium-sized endoscopy centers that regularly perform ERCP. [ 11 , 18 ] In addition, the overall rate of complications was 9.1% in patients with cirrhosis, and the 30-day procedure-related complications included PEP (4.6%), cholangitis (2.8%), bleeding (1.1%), aspiration pneumonia (0.9%), perforation (0.4%), and bile leak (0.2%).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ERCP in patients with gastroesophageal varices

Hong¹,

Zuo²,

Wang³

et al. 2020

Medicine

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Addressing pancreaticobiliary disorders concomitant with gastroesophageal varices remains challenging. The goal of this study was to evaluate and compare the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotic and noncirrhotic patients with gastroesophageal varices. We retrospectively analyzed the data of consecutive patients with gastroesophageal varices who underwent ERCP. Two hundred seventy ERCP procedures were performed on 208 patients. The overall technical success rate was 98.5%, and no difference was found between cirrhotic and noncirrhotic patients (98.7% vs 97.7%, P = .511); of these, endoscopic retrograde biliary drainage, endoscopic metal biliary endoprosthesis placement, endoscopic retrograde pancreatic drainage, and stone extraction were conducted in 173/270 (64.1%), 27/270 (10.0%), 26/270 (9.6%), and 116/270 (43.0%) cases, respectively. Endoscopic retrograde biliary drainage and stone extraction were more frequently performed in cirrhotic cases (67.7% versus 45.5%, P = .005; 46.5% versus 25.0%, P = .009, respectively), while the noncirrhotic group had significantly higher rates of endoscopic metal biliary endoprosthesis placement (31.8% versus 5.8%, P = .000) and endoscopic retrograde pancreatic drainage (18.2% versus 8.0%, P = .036) than the cirrhotic group. The overall rate of adverse events was 21.1%, including fever (6.7%), post-ERCP pancreatitis ( 3.0%), hyperamylasemia (6.3%), duodenal papilla bleeding (3.3%), cardiac mucosal laceration (1.1%), and perforation (0.4%). No differences in any of the adverse events were found between the 2 groups. Additionally, gastroesophageal variceal bleeding occurred in 1 patient with grade III varices 7 days after ERCP. ERCP may be effective and safe for patients with gastroesophageal varices, irrespective of the etiologies caused by liver cirrhosis.

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Risk factors associated with complications in cirrhotic patients undergoing endoscopic retrograde cholangio-pancreatography

Cited by 12 publications

References 23 publications

The risk of variceal bleeding during endoscopic retrograde cholangiopancreatography

The risk of variceal bleeding during endoscopic retrograde cholangiopancreatography

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

Efficacy and safety of ERCP in patients with gastroesophageal varices

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