Yonsei Med J.  2019 May;60(5):440-445. 10.3349/ymj.2019.60.5.440.

Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis

• Kim JY
• Lee HS
• Chung MJ
• Park JY
• Park SW
• Song SY
• Bang S

• KMID: 2443247
• DOI: http://doi.org/10.3349/ymj.2019.60.5.440

Abstract

PURPOSE
Patients with liver cirrhosis are considered to be at risk for additional adverse events during endoscopic retrograde cholangiopancreatography (ERCP). The present study was designed as a propensity-score matched analysis to investigate whether cirrhotic liver increases the risk of bleeding complications in patients undergoing ERCP.
MATERIALS AND METHODS
In total, 8554 patients who underwent ERCP from January 2005 to December 2015 were retrospectively analyzed. To adjust for the imbalance between patients with and those without liver cirrhosis, 1:3 propensity score matching was performed according to age and sex.
RESULTS
Liver cirrhosis was identified in 264 (3.1%) patients. After propensity score matching, a total of 768 patients were included in each of the cirrhotic (n=192) and non-cirrhotic groups (n=576). Post-procedure bleeding (10.9% vs. 4.7%, p=0.003) was more frequently observed in patients with liver cirrhosis than in those without. In multivariate analyses, liver cirrhosis was identified as an independent risk factor associated with post-ERCP bleeding (p=0.003) after further adjustment for prothrombin time, antiplatelet/coagulant, duration of ERCP, and stent insertion. Child-Pugh (CP) class C was found to be associated with an increased incidence of post-ERCP bleeding in patients with cirrhosis (odds ratio 6.144, 95% confidence interval 1.320-28.606; p=0.021).
CONCLUSION
The incidence of post-ERCP bleeding in patients with liver cirrhosis was higher than that in patients without liver cirrhosis. In particular, CP class C cirrhosis was significantly associated with post-ERCP bleeding.

Keyword

Liver cirrhosis; endoscopic retrograde cholangiopancreatography; hemorrhage

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde*
Fibrosis
Hemorrhage*
Humans
Incidence
Liver Cirrhosis*
Liver*
Multivariate Analysis
Propensity Score
Prothrombin Time
Retrospective Studies
Risk Factors
Stents

Figure

• 

  Fig. 1 Flow diagram of patient selection. ERCP, endoscopic retrograde cholangiopancreatography.

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