EXPLORING THE SAFETY OF CONDUCTING ERCP IN DECOMPENSATED CIRRHOSIS: INSIGHTS FROM A QUATERNARY CARE TRANSPLANT CENTER

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a cornerstone in the treatment of pancreatobilliary disorders. Studies have shown a mixed picture in regard to safety in cirrhotic patients, with the greatest risk being in patients with decompensated disease. Despite these safety concerns Gastroenterologists are frequently asked to perform ERCP on these patients, especially in transplant centers. We aim to further study the safety of ERCP and specific therapeutic interventions among patients with cirrhosis. Methods: We conducted a retrospective chart review on all adult (18 years and older) patients with cirrhosis who underwent ERCP at our center between 1/2015 and 11/2023. Patients with post-liver transplant status were excluded from our analysis. Data including basic patient demographics, markers of liver function, procedure indication, details including specific procedural techniques and tools, as well as morbidity were collected. Results: A total of 277 patients with cirrhosis who underwent ERCP were included, 181 (65.3%) were males, 183 (66.1%) were causasian. Alcohol was the most common etiology of cirrhosis in 108 (38.9%) patients. Most common indication for ERCP was jaundice in 99 (35.7%) patients. 37 (13.3%) patients were on long term anti-coagulation. 170 (61.4%) patients had an average MELD of (19.15, SD 8.4) at time of ERCP. Comparing patients who had post-ERCP adverse events (AEs) to those who didn’t, patients with higher MELD scores (23.9 ± 7.5 vs. 17.3 ± 8.0, P<0.001), higher INR (1.6 ± 0.5 vs. 1.4 ± 0.3, P<0.001), ascites (76.0% vs. 56.3%, P=0.003), hepatic encephalopathy (54.7% vs. 34.3%, P=0.002), Hepatorenal Syndrome (HRS) (33.8% vs. 13.4%, P<0.001), and Hyponatremia (50.7% vs. 34%, P= 0.012) had higher rates of AEs in general. Interestingly, patients with SBP and thrombocytopenia didn’t have statistically significant higher rates of AEs (P=0.158 and 0.062). Patients who were given blood products had higher rates of AEs post-ERCP (13.3% vs. 3.5%, P=0.002). Inpatient procedures had higher rates of AEs than outpatient procedures (74.7% vs. 54.5%, P=0.002). Conclusion: Patients with decompensated liver disease, higher MELD,and elevated INR had a higher risk of AEs after ERCP. Interestingly patients with SBP and thrombocytopenia didn’t show higher risk of AEs after ERCP. Prior to performing ERCP in patients with cirrhosis with high risk features should be optimized, if possible to limit AEs.

Volume

99

Issue

6

First Page

AB656

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