Bernshteyn M, Hu L, Masood U, Sharma AV, Huang D, Sapkota B. Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis. World J Hepatol 2021; 13(4): 472-482 [PMID: 33959228 DOI: 10.4254/wjh.v13.i4.472]
Corresponding Author of This Article
Michelle Bernshteyn, MD, Doctor, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13202, United States. bernshtm@upstate.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Hepatol. Apr 27, 2021; 13(4): 472-482 Published online Apr 27, 2021. doi: 10.4254/wjh.v13.i4.472
Retrospective analysis of complications related to endoscopic retrograde cholangio-pancreatography in patients with cirrhosis vs patients without cirrhosis
Michelle Bernshteyn, Linda Hu, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
Umair Masood, Anuj Vikrant Sharma, Division of Gastroenterology and Hepatology, State University of New York Upstate Medical University, Syracuse, NY 13210, United States
Danning Huang, Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
Bishnu Sapkota, Division of Gastroenterology and Hepatology, SUNY Upstate Medical University and Syracuse VA Medical Center, Syracuse, NY 13210, United States
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The SUNY Upstate IRB has determined this project is exempt from Institutional Review Board (IRB) review according to federal regulations.
Informed consent statement: Informed consent was not obtained from the participants as this is a retrospective study with no identifying information. Confirmation was obtained from the journal’s technical support.
Conflict-of-interest statement: There are no conflicts of interest with any of the authors.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Michelle Bernshteyn, MD, Doctor, Department of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13202, United States. bernshtm@upstate.edu
Received: January 26, 2021 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
Abstract
BACKGROUND
There is minimal objective data regarding adverse events related to endoscopic retrograde cholangio-pancreatography (ERCP) in patients with cirrhosis compared to those without cirrhosis and even fewer data comparing complications among cirrhosis patients based on severity of cirrhosis.
AIM
To determine if patients with cirrhosis are at increased risk of adverse events related to ERCP: mainly pancreatitis, bleeding, perforation, cholangitis, and mortality; And to see if higher Child-Pugh (CP) score and Model for End-Stage Liver Disease (MELD) score are associated with higher post-ERCP complications.
METHODS
We performed a retrospective analysis of 692 patients who underwent ERCP and analyzed the impact of cirrhosis etiology, gender, type of sedation used during procedure, interventions performed, and co-morbidities on the rate of complications in cirrhosis patients as compared to non-cirrhosis patients.
RESULTS
Overall complications were higher in those with cirrhosis as compared to those without cirrhosis (P = 0.015 at significance level of 0.05). CP class, especially CP class C, was shown to be associated with a significantly higher rate of ERCP complications as compared to CP class A and CP class B (P = 0.010 at significance level of 0.05).
CONCLUSION
The results of our study reaffirm that liver cirrhosis has an impact on the occurrence of complications during ERCP. Our study shows that CP class seems to be more reliable as compared to MELD score in predicting complications of ERCP in cirrhosis patients.
Core Tip: What is previously known is that endoscopic retrograde cholangio-pancreatography is associated with a risk of adverse events. What is new in this manuscript is that complications are increased in patients with cirrhosis as compared to patients without cirrhosis. Statistical significance was demonstrated in patients classified as Child-Pugh (CP) Class C as compared to CP Classes A and B.
