Factors Associated With Worsening Ascites Following ERCP in Cirrhotic Patients: A Retrospective Analysis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Even in patients with liver cirrhosis, ERCP remains the gold standard treatment for pancreatic and biliary diseases. These patients are more likely to have adverse outcomes. We investigated the worsening of ascites as a complication of ERCP in cirrhosis patients. Methods: A retrospective chart review was carried out on all cirrhosis patients aged 18 years and above who had an ERCP at our center between January 2015, and November 2023. Our analysis did not include any patients with liver transplants. Basic patient demographics, ERCP indications, liver function markers, ERCP indications, and morbidity were among the collected data. Results: In patients with cirrhosis who underwent ERCP (n=277), 181 (65.3%) were males, 183 (66.1%) were white. The most common etiology of cirrhosis was alcohol in 108 (38.9%) patients. Jaundice was the most common indication for ERCP in 99 (35.7%) patients. The course of 22 (8%) patients was complicated by worsening ascites post procedural. Comparing those whose ERCP course was complicated by worse ascites to those who did not, patients with worsening ascites were more likely to have a higher MELD score at the time of ERCP (25.6 ± 8.0 vs. 18.6 ± 8.2, P< 0.001), higher INR (1.6 ± 0.5 vs. 1.4 ± 0.4, P = 0.049), and performed inpatient vs. outpatient (81.8% vs. 58.0%, P=0.029). Additionally, they had a higher incidence of ascites (90.9% vs. 59.1%, P=0.003) HRS (38.1% vs. 17.3%, P=0.019), and hyponatremia (63.6% vs. 36.4%, P=0.012) at presentation. Conclusion: While ERCP continues to be an invaluable procedure for therapeutic and diagnostic interventions in pancreatic and biliary disorders, patients with liver cirrhosis have more risks for post-ERCP complications including ascites. Patients who have ascites at presentation have a higher risk for worsening ascites after ERCP. Patients with higher MELD score, higher INR, HRS, hyponatremia at the time of ERCP and those who are getting the procedure as inpatient have a higher risk of developing worsening ascites post ERCP. Understanding the specific risk factors associated with post-ERCP complications in patients with liver cirrhosis is crucial for optimal patient care and to lower rates of complications.

Volume

119

Issue

10

First Page

S1147

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