Safety of ERCP in patients with liver cirrhosis: a national database study
نویسندگان
چکیده
Background and aims Given the limited data on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis, we attempted to evaluate this question using a large national database. Methods We conducted a matched case - control study using the 2010 National Inpatient Sample database in which four non-cirrhotic controls were matched randomly for every cirrhotic patient from the same 10-year age group. We compared adverse events and safety of inpatient ERCP between patients with (n = 3228) and without liver cirrhosis (controls, n = 12 912). Results Of the 3228 cirrhotic patients, 2603 (80.6 %) had decompensated and 625 (19.4 %) had compensated disease. Post-procedure bleeding (2.1 % vs. 1.2 %, P < 0.01) was higher in patients compared to controls. On multivariable analysis, decompensated cirrhosis (adjusted odds ratio [aOR], 2.7; 95 % confidence interval [CI], 2.2 - 3.2), compensated cirrhosis (aOR 2.2; 95 %CI 1.2 - 3.9), therapeutic ERCPs (aOR 1.4; 95 % CI 1.2 - 2.1), and biliary sphincterotomy (aOR 1.6; 95 %CI 1.1 - 2.1) were independently associated with increased risk of post-procedure bleeding. Performing ERCPs in large (aOR 0.5; 95 %CI 0.4 - 0.6) and medium (aOR 0.7; 95 %CI 0.6 - 0.9) sized hospitals was associated with a decreased risk of post-procedure bleeding. Biliary sphincterotomy (aOR 1.7; 95 %CI 1.2 - 2.3) and therapeutic ERCPs (aOR 1.1; 95 %CI 1.1 - 1.3) increased the risk of post-ERCP pancreatitis, and pancreatic stent placement was associated with a decreased risk of post-ERCP pancreatitis (aOR 0.8; 95 %CI 0.7 - 0.9). Conclusions Cirrhosis (both compensated and decompensated), performing therapeutic ERCPs and biliary sphincterotomy increase the risk of post-procedure bleeding. Performing ERCPs in large and medium sized hospitals may improve outcomes.
منابع مشابه
Outcomes and Safety of Open vs. Laparoscopic Surgery in Patients with Cirrhosis
How to cite this article Cohen SM, Dholakia A, VanderHeyden TR, Pillai A and Ahn J. Outcomes and Safety of Open vs. Laparoscopic Surgery in Patients with Cirrhosis. J Gastroenterol. 2015;1(1):1001. OPEN ACCESS Abbreviations: ASA: American Association of Anesthesiologists; ERCP: Endoscopic Retrograde Cholangiopancreatogram; HD: Hepatic Decompensation; ICU: Intensive Care Unit; INR: International...
متن کاملContrast Enhanced Echocardiography for Detection of Intrapulmonary Shunts in Liver Transplant Candidates
Background: Intrapulmonary vascular abnormalities associated with liver cirrhosis may result in intrapulmonary right-to-left shunt and hypoxemia. The aim of this study was to use contrast enhanced echocardiography to detect intrapulmonary vascular abnormalities in patients with liver cirrhosis candidates for liver transplantation. Methods: One hundred and two adult patients underwent contrast e...
متن کاملA Minimum Data Set of Educational Self-care Software for Patients with Cirrhosis
Introduction: Liver cirrhosis has grown significantly in Asian countries over the last few years. However, there is no tool for collecting liver cirrhosis data. The purpose of this study was to design a minimum data set for the self-care education of liver cirrhosis. Methods: This descriptive study was conducted in the first half of 2018 in cooperation with 16 liver specialists of Rasool Akram ...
متن کاملThe Increased Level of Serum p53 in Hepatitis B-Associated Liver Cirrhosis
Background: The ability of tumour suppressor protein p53 (P53) to regulate cell cycle processes can be modulated by hepatitis B virus (HBV). While preliminary evidences indicates the involvement of protein-x of HBV (HBx) in altering p53 DNA binding, no further data have been accumulated for the significance of serum p53 in chronic hepatitis B virus infected patients. Methods: 72 non-cirrhotic a...
متن کاملReal-life efficacy of generic sofosbuvir/ledipasvir for treatment of Iranian patients with chronic hepatitis C: A cohort study
Background: Treatment of hepatitis C virus (HCV) infection with recently introduced direct-acting antiviral agents (DAA) is effective and safe, however there is little known regarding safety and efficacy of generic DAAs in the real-life clinical setting. This study aimed to evaluate the efficacy and safety of generic sofosbuvir/ledipasvir (SOF/LDV) in a real-life clinical experience. Methods: ...
متن کامل