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Outcomes of endoscopic retrograde cholangiopancreatography in patients with cirrhosis

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Background: ERCP is commonly performed in cirrhotics, they are at increased risk of bleeding after

ERCP, but the incidence and risk-factors in this population is not well described. The aim of this study

was to examine the incidence of post-ERCP complications.

Methods: We evaluated all ERCP’s performed in cirrhotics at our practice from 2008 to 2014. We

analyzed a matched control group of non-cirrhotic with ERCP during same period. Patient and

procedure-related risk factors were analyzed. Predictive factors for post-ERCP complications were

determined by univariate and multivariate analysis

Results: 200 ERCP’s were analyzed (100 in cirrhotic and 100 in non-cirrhotic patients). Complications

occurred in 14 patients (14%) in the cirrhosis group (11-mild, 3-severe): pancreatitis 3 cases (3%),

cholangitis 3 cases (3%), and post-sphincterotomy bleeding 6 cases (6%). The overall rate of

complications were significantly higher in patients with cirrhosis (14% vs 6.4%, P = 0.04). Bleeding

occurred more commonly in patients with cirrhosis compared to non-cirrhotics (7.0%) vs (1.7%), P =

0.03]. The incidence of pancreatitis and cholangitis were not different in both groups. Logistic regression

identified sphincterotomy [OR 8.99 (CI 1.08–74.60), P = 0.04] and cirrhosis [OR 3.51 (CI 1.11–11.09), P =

0.03] as independent risk factors of post-ERCP complications, whereas cirrhosis was the only

independent risk factor of post sphincterotomy bleeding [OR 4.12 (CI 1–16.93), P=0.04].

Conclusions: The rate of complications after ERCP in patients with cirrhosis (14%) is higher than that of

non-cirrhotics. Cirrhosis and sphincterotomy are risk factors of post ERCP complications.

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