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Medline ® Abstract for Reference 24

of 'Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding'

24
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Decompensated cirrhosis may be a risk factor for adverse events in endoscopic retrograde cholangiopancreatography.
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Inamdar S, Berzin TM, Berkowitz J, Sejpal DV, Sawhney MS, Chutanni R, Pleskow DK, Trindade AJ
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Liver Int. 2016;36(10):1457.
 
BACKGROUND AND AIMS: There are limited data regarding the safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis. The current literature consists of small series totalling less than 225 patients.
METHODS: Retrospective matched cohort study of the National Inpatient Sample (NIS) for 2009. We compared adverse events of cirrhotic patients who underwent ERCP (n = 1930) with a matched control group that consisted of randomly selected non-cirrhotic patients who underwent ERCP (n = 5790). An additional control group, to measure cirrhosis-related adverse events, consisted of cirrhotic patients undergoing non-pancreaticobiliary endoscopy.
RESULTS: ERCP-associated adverse events of post-ERCP pancreatitis (PEP) (8.3% vs. 5.5%) and bleeding (2.3% vs. 1.0%) were more common in the cirrhosis cohort vs. the non-cirrhosis cohort (all P<0.05). In subgroup analysis, compensated cirrhotic patients (n = 1308) had a similar adverse event profile to non-cirrhotic controls except for a slightly higher rate of PEP (7.7% vs. 5.5%; P<0.05). However, decompensated cirrhotic patients (n = 622) had statistically significant higher rates of PEP (9.7% vs. 5.5%) and bleeding (4.3% vs. 1.0%), compared with non-cirrhotic controls respectively (P<0.05). In regard to cirrhosis-related adverse events, cirrhotic patients undergoing ERCP were more likely to develop bacterial peritonitis vs. cirrhotic patients undergoing non-pancreaticobiliary endoscopy (2.2% vs. 1.1%; P<0.005).
CONCLUSION: ERCP adverse events were statistically higher among patients with decompensated cirrhosis. This increased risk needs to be confirmed with prospective studies. A thorough risk/benefit assessment should be performed prior to performing ERCP in decompensated cirrhotic patients.
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Division of Gastroenterology, Hofsta Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA.
PMID