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Adverse events, liver failure common after ERCP in cirrhosis

Adverse events occurred more often among patients with cirrhosis than noncirrhotic cases after endoscopic retrograde cholangiopancreatography and correlated with a higher incidence of acute chronic liver failure, according to a recently published study.

“Recent studies demonstrate that ERCP is safe in patients with cirrhosis, but not surprisingly, those with [Child-Pugh class] B and C have higher adverse-event rates compared with those with [Child-Pugh class] A,” Carles Leal, MD, from the University of Barcelona in Spain, and colleagues wrote. “The study demonstrates that independent risk factors of ERCP adverse events in all patients were the presence of cirrhosis and sphincterotomy and the presence of cirrhosis was an independent risk factor for post-ERCP cholangitis.”

The retrospective analysis included 158 ERCP procedures in patients with cirrhosis and 283 control cases. Post-ERCP adverse events occurred in 17.1% of the cirrhotic group and 9.5% of the control (P = .02).

In a subanalysis of patients with sphincterotomy, patients with cirrhosis had a significantly higher bleeding rate than controls (9.4% vs. 3.4%; P = .03) and were more likely to develop cholangitis (6.3% vs. 1.8%; P = .01).

The researchers identified cirrhosis (OR = 2.48; 95% CI, 1.36-4.53) and sphincterotomy (OR = 2.66; 95% CI, 1.23-5.72) as independent risk factors for post-ERCP adverse events and cirrhosis (OR = 3.74; 95% CI, 1.26-11.16) as an independent risk factor for post-ERCP cholangitis. Additionally, they confirmed that patients with cirrhosis had a significantly higher risk for bleeding compared with controls (OR = 2.85; 95% CI, 1.07-7.64).

Among the patients with cirrhosis, 18 (11.4%) developed ACLF within the first month after ERCP. Procedures without adverse events correlated with ACLF in 8.3% of cases, whereas those with adverse events developed ACLF in 25.9% of cases (P = .01). ACLF risk also increased in patients with a prior decompensation event before undergoing ERCP (17% vs 6.8%; P = .049).

“The most novel finding of this study was the occurrence of ACLF after ERCP,” the researchers wrote. “ACLF in this population of patients can be precipitated by numerous factors which include preceding events before the ERCP, manipulation of the bile duct, and adverse events after an ERCP. This is particularly true in those with decompensated cirrhosis.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.