Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis
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Background/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact ofChild-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patientswith cirrhosis compared with those without cirrhosis. Methods: We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patientswith hepatic cirrhosis. Results: Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosiswas 15.5% (95% confidence interval [CI], 11.8%–19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI,3.1%–7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%–4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%–3.8%; I2=83.4%), and perforation0.3% (95% CI, 0.1%–0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41;95% CI, 1.16–1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis(RR, 1.25; 95% CI, 1.06–1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59–2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77–1.70;I2=12%), and perforation (RR, 1.20; 95% CI, 0.59–2.43; I2=0%). Conclusions: Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.
Abstract
Background/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact ofChild-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patientswith cirrhosis compared with those without cirrhosis. Methods: We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patientswith hepatic cirrhosis. Results: Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosiswas 15.5% (95% confidence interval [CI], 11.8%–19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI,3.1%–7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%–4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%–3.8%; I2=83.4%), and perforation0.3% (95% CI, 0.1%–0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41;95% CI, 1.16–1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis(RR, 1.25; 95% CI, 1.06–1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59–2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77–1.70;I2=12%), and perforation (RR, 1.20; 95% CI, 0.59–2.43; I2=0%). Conclusions: Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.
참고문헌 (37)
- Trap R, "Severe and fatal complications after diagnostic and therapeutic ERCP : a prospective series of claims to insurance covering public hospitals", Endoscopy, 31, pp.125~130 (1999)
- Adler DG, "ASGE guideline : the role of ERCP in diseases of the biliary tract and the pancreas", Gastrointest Endosc, 62, pp.1~8 (2005)
- Alkhatib AA, "Comorbidities, sphincterotomy, and balloon dilation predict post-ERCP adverse events in PSC patients : operator experience is protective", Dig Dis Sci, 56, pp.3685~3688 (2011)
- Andriulli A, "Incidence rates of post-ERCP complications : a systematic survey of prospective studies", Am J Gastroenterol, 102, pp.1781~1788 (2007)
- Coelho-Prabhu N, "Endoscopic retrograde cholangiopancreatography : utilisation and outcomes in a 10-year population-based cohort", BMJ Open, 3, pp.e002689~ (2013)
- Zhang J, "MELD scores and Child-Pugh classifications predict the outcomes of ERCP in cirrhotic patients with choledocholithiasis: a retrospective cohort study", Medicine(Baltimore), 94, pp.e433~ (2015)
- Navaneethan U, "Safety of ERCP in patients with liver cirrhosis : a national database study", Endosc Int Open, 5, pp.E303~ (2017)
- Farooq U, "How does cirrhosis impact mortality, morbidity, and resource utilization in non-variceal upper gastrointestinal bleeding? A nationwide analysis", Gastroenterol Rev, 2022, pp.17, ~
- Mosko JD, "Increased perioperative mortality following bariatric surgery among patients with cirrhosis", Clin Gastroenterol Hepatol, 9, pp.897~901 (2011)
- Yang H, "Safety and efficacy of common endoscopic treatments in patients with decompensated liver cirrhosis", Ann Hepatol, 27, pp.100689~ (2022)
- Bernshteyn M, "Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis", World J Hepatol, 13, pp.472~482 (2021)
- Hong J, "Efficacy and safety of ERCP in patients with gastroesophageal varices", Medicine(Baltimore), 99, pp.e22051~ (2020)
- Kundumadam S, "Bleeding after elective interventional endoscopic procedures in a large cohort of patients with cirrhosis", Clin Transl Gastroenterol, 11, pp.e00288~ (2020)
- 김지연, "Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis", Yonsei Medical Journal, 60(5), pp.440~445 (2019), 연세대학교의과대학[DOI]
- Yoo T, "Evaluating the risk of adverse events with interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound procedures in cirrhotic patients", World J Gastrointest Endosc, 11, pp.523~530 (2019)
- Jagtap N, "Is it safe to perform endoscopic retrograde cholangiopancreatography in decompensated cirrhosis?", J Clin Exp Hepatol, 9, pp.554~560 (2019)
- Leal C, "Adverse events and acute chronic liver failure in patients with cirrhosis undergoing endoscopic retrograde cholangiopancreatography : a multicenter matched-cohort study", Am J Gastroenterol, 114, pp.89~97 (2019)
- Lee JC, "Outcome of endoscopic retrograde cholangiopancreatography in patients with clinically defined decompensated liver cirrhosis", J Dig Dis, 19, pp.605~613 (2018)
- Peiseler M, "Risk of endoscopic biliary interventions in primary sclerosing cholangitis is similar between patients with and without cirrhosis", PLoS One, 13, pp.e0202686~ (2018)
- Macías-Rodríguez RU, "Risk factors associated with complications in cirrhotic patients undergoing endoscopic retrograde cholangio-pancreatography", Eur J Gastroenterol Hepatol, 29, pp.238~243 (2017)
- Adler DG, "Efficacy and safety of therapeutic ERCP in patients with cirrhosis : a large multicenter study", Gastrointest Endosc, 83, pp.353~359 (2016)
- Inamdar S, "Decompensated cirrhosis may be a risk factor for adverse events in endoscopic retrograde cholangiopancreatography", Liver Int, 36, pp.1457~1463 (2016)
- Churrango J, "Sa1171 Predictors of post-ERCP complications in patients with liver cirrhosis", Gastrointest Endosc, 83, pp.AB240~AB241 (2016)
- Gill M, "Outcomes of endoscopic retrograde cholangiopancreatography in patients with cirrhosis", J Hepatol, 64, pp.S278~ (2016)
- Li DM, "Safety and efficacy of endoscopic retrograde cholangiopancreatography for common bile duct stones in liver cirrhotic patients", J Huazhong Univ Sci Technolog Med Sci, 34, pp.612~615 (2014)
- Ma MY, "ERCP for treatment of choledocholithiasis in patients with liver cirrhosis", Shijie Huaren Xiaohua Zazhi, 21, pp.3736~3741 (2013)
- Artifon EL, "Management of common bile duct stones in cirrhotic patients with coagulopathy : a comparison of supra-papillary puncture and standard cannulation technique", Dig Dis Sci, 56, pp.1904~1911 (2011)
- Park DH, "Endoscopic sphincterotomy vs. endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy", Gastrointest Endosc, 60, pp.180~185 (2004)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
- Prat F, "Endoscopic sphincterotomy in patients with liver cirrhosis", Gastrointest Endosc, 43(2 Pt 1), pp.127~131 (1996)
- Sugiyama M, "Treatment of choledocholithiasis in patients with liver cirrhosis : surgical treatment or endoscopic sphincterotomy?", Ann Surg, 218, pp.68~73 (1993)
- Farooq U, "Validation of Tokyo guidelines 2018 for safety and mortality benefit from urgent ERCP in acute cholangitis across different age groups", J Hepatobiliary Pancreat Sci, 30, pp.737~744 (2023)
- Kullman E, "Bacteremia following diagnostic and therapeutic ERCP", Gastrointest Endosc, 38, pp.444~449 (1992)
- Szary NM, "Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them", Gastroenterol Hepatol(N Y), 9, pp.496~504 (2013)
- Enns R, "ERCP-related perforations : risk factors and management", Endoscopy, 34, pp.293~298 (2002)
- Fatima J, "Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures : diagnosis and management", Arch Surg, 142, pp.448~455 (2007)
- Mashiana HS, "Endoscopic retrograde cholangiopancreatography in cirrhosis : a systematic review and meta-analysis focused on adverse events", World J Gastrointest Endosc, 10, pp.354~366 (2018)