Endoscopy 2018; 50(04): S200
DOI: 10.1055/s-0038-1637655
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

COMPLICATIONS OF ENDOSCOPIC RETROGRAPHY CHOLANGIOPANCREATOGRAPHY (ERCP) IN PATIENTS WITH LIVER CIRRHOSIS

M Alcivar-Leon
1   HOSPITAL IESS TEODORO MALDONADO CARBO, Gastroenterology, GUAYAQUIL, Ecuador
,
M Guaranda-Maya
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
A Serrano-Suarez
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
J Carrillo-Ubidia
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
ML Jara-Alba
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
M Caballero-Giler
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
L Frugone-Morla
3   Hospital Clinica Kennedy, Gastroenterology, Guayaquil, Ecuador
,
L Aynaguano-Colcha
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
A Gallegos-Lozano
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
E Vera-Pozo
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
D Marriott-Blum
4   Universidad Espiritu Santo, Guayaquil, Ecuador
,
E Villacis-Coronel
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
I Nieto-Orellana
5   Instituto Oncologico Nacional Solca, Gastroenterology, Guayaquil, Ecuador
,
K Mönkemüller
6   Frankenwald Klinik, Gastroenterology, Kronach, Germany
,
E Marriott-Diaz
2   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

To evaluate the safety and efficacy of ERCP for common bile duct stones in liver cirrhotic patients and to determine risk factors, rate and type of complications.

Methods:

We retrospectively analyzed the data of 796 ERCPs performed in three centers in Guayaquil, Ecuador (IESS, SOLCA, KENNEDY) between October 2013 and October 2017. In total, 102 consecutive cirrhotic patients with choledocholithiasis undergoing ERCP for the first time were enrolled..

The following parameters were analyzed: success rates of selective biliary cannulation, number of ERCPs for stones extraction and complications within 7 days after ERCP. We evaluated the ability of Child-Pugh classification scores to predict the outcomes in these patients. There were 23 cases of Child-Pugh A, 60 cases of Child-Pugh B, and 19 cases of Child-Pugh C.

Results:

The success rate of selective biliary cannulation was 95.6% in cirrhotic patients versus 97% in non-cirrhotics. The bile duct clearance rate was 87% in cirrhotics versus 96% in non-cirrhotics (P > 0.05),

Complications occurred in 24 procedures (24.4%): hemorrhage in 19 patients (79.1%), of these 1 was Child A, 5 Child B, and 13 were Child C. Acute pancreatitis in 1 patient (4.1%), cholangitis in 4 patients (16.6%). All were mild except for a severe case of bleeding. Mortality was zero. The main risk factor associated with the development of complications was endoscopic sphincterotomy. The hemorrhage rate after ERCP in non-cirrhotic patients was 1%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (18.6%) than that (1%) in non-cirrhotic patients.

Conclusions:

The complication rate of ERCP in patients with underlying liver cirrhosis was 24.4%, mainly manifested as hemorrhage, however occurring more commonly in Child-Pugh C status. ERCP is a safe and effective treatment for Child-Pugh A and B cirrhotic patients with common bile duct stones.