DO CIRRHOTIC PATIENTS HAVE HIGHER RISK OF COMPLICATION FOLLOWING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY? A SINGLE CENTER STUDY

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important procedures in the diagnosis and treatment of pancreaticobiliary disease. However, there is still insufficient data on the complication rate of ERCP in patients with liver cirrhosis (LC). The aim of this study was to investigate the rate of complications following ERCP in cirrhotic patients.

Methods A total of 51 patients with liver cirrhosis having CBD stones, who underwent ERCP at Yeungnam University Hospital from 2006 to 2017, were reviewed retrospectively and compared with age- and sex-matched non-cirrhotic patients (n=102). Clinical outcomes and the rate of complication were investigated.

Results Of 51 LC patients, Child-Pugh class A was 24 (47.1%), B, 16 (31.4%) and C, 11 (21.6%), respectively and the number of decompensated LC was 30 (58.8%). The rate of endoscopic sphincterotomy was higher in non-LC patients (76.5% vs. 58.8%, p=0.038) and the rate of balloon dilatation was higher in LC (41.2% vs. 22.5%, p=0.027). There was no statistical difference regarding pancreatitis, cholangitis and perforation between two groups. The incidence of bleeding in cirrhotic patient was significantly higher than in non-cirrhotic group (17.6% vs 4.9%, p=0.023) and in particular, immediate bleeding rate was higher in LC (13.7% vs. 2.9%, p=0.028). The rate of complications in patients with LC was not significantly different regardless of Child-Pugh score or the presence decompensated liver.

Conclusions Cirrhotic patients have a significant bleeding risk following ERCP procedure compared with non-cirrhotic patients. A large, prospective study is needed for elucidating the further outcomes of ERCP in cirrhotic patients.