Predictive Factors of Post-ERCP Hepatic Decompensation in Patients with Cirrhosis: A Retrospective Case-Control Study

Authors

Mohammed Abusuliman, Henry Ford HealthFollow
Sanad Dawod, Henry Ford HealthFollow
Faisal M. Nimri, Henry Ford HealthFollow
Taher Jamali, Henry Ford HealthFollow
Gordon Jacobsen, Henry Ford HealthFollow
Muhammad Z. Khan, Henry Ford HealthFollow
Remy Arwani, Henry Ford HealthFollow
Omar Shamaa, Henry Ford HealthFollow
Suhaib Alhaj Ali, Henry Ford HealthFollow
Spandana Alluri, Henry Ford HealthFollow
Rami M. Youssef, Henry Ford HealthFollow
Abdulmalik Saleem, Henry Ford HealthFollow
Ahmad Alomari, Henry Ford HealthFollow
Muhammad S. Faisal, Henry Ford HealthFollow
Haya Omeish, Henry Ford HealthFollow
Muhammad S. Faisal, Henry Ford HealthFollow
Amr Abusuliman
Sumit Singla, Henry Ford HealthFollow
Cyrus Piraka, Henry Ford HealthFollow
Mazen M. El-Atrache, Henry Ford HealthFollow
Tobias Zuchelli, Henry Ford HealthFollow

Recommended Citation

Abusuliman M, Dawod S, Nimri F, Jamali T, Jacobsen G, Khan MZ, Arwani R, Shamaa O, Ali SA, Alluri S, Youssef R, Saleem A, Alomari A, Faisal MS, Omeish H, Faisal MS, Abusuliman A, Singla S, Piraka C, Elatrache M, and Zuchelli T. Predictive Factors of Post-ERCP Hepatic Decompensation in Patients with Cirrhosis: A Retrospective Case-Control Study. Dig Dis Sci 2025.

Document Type

Article

Publication Date

4-24-2025

Publication Title

Digestive diseases and sciences

Abstract

BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial diagnostic and therapeutic procedure in patients with cirrhosis; however, it carries the risk of post-procedural hepatic decompensation. This study aims to identify predictive factors associated with post-ERCP hepatic decompensation in patients with cirrhosis to better inform clinical decision-making and minimize adverse outcomes.

METHODS: A retrospective analysis was conducted on patients with cirrhosis undergoing ERCP. Clinical, biochemical, and procedural variables were evaluated to determine their association with hepatic decompensation. Multivariate analysis was performed to identify independent predictors.

RESULTS: A total of 277 patients with cirrhosis who underwent an ERCP were included. The cohort had a mean age of 63.4 years, with a male predominance (65.3%) and various etiologies of cirrhosis, including alcohol-related (39.3%) and hepatitis C (11.4%). Post-ERCP complications occurred in 26.7% of patients. The most common complications were hepatic decompensation events (18.4%), sepsis (10.8%), and cholangitis (6.1%). Patients with complications had significantly higher baseline MELD scores, INR, chronic kidney disease (CKD) and history of ascites, hepatic encephalopathy, and hepatorenal syndrome (HRS). A Multivariate analysis revealed that factors such as higher MELD score, ascites, hepatic encephalopathy, and stent placement were associated with post-ERCP complications. Subgroup analyses indicated that patients who developed hepatic decompensation events (ascites, SBP, or HRS) had a more severe liver dysfunction at baseline, as reflected by a higher MELD score and INR, and prior episodes of ascites and hepatic encephalopathy.

CONCLUSION: Pre-procedural liver function parameters and procedural factors are crucial predictors of post-ERCP hepatic decompensation in patients with cirrhosis. Key risk factors include higher MELD score, CKD, history of ascites, and hepatic encephalopathy. Careful pre-procedural evaluation and management are essential to reduce these risks.

PubMed ID

40274678

ePublication

ePub ahead of print