Decompensated cirrhosis may be a risk factor for adverse events in endoscopic retrograde cholangiopancreatography

There are limited data regarding the safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis. The current literature consists of small series totalling less than 225 patients.

Retrospective matched cohort study of the National Inpatient Sample (NIS) for 2009. We compared adverse events of cirrhotic patients who underwent ERCP (n = 1930) with a matched control group that consisted of randomly selected non-cirrhotic patients who underwent ERCP (n = 5790). An additional control group, to measure cirrhosis-related adverse events, consisted of cirrhotic patients undergoing non-pancreaticobiliary endoscopy.

ERCP-associated adverse events of post-ERCP pancreatitis (PEP) (8.3% vs. 5.5%) and bleeding (2.3% vs. 1.0%) were more common in the cirrhosis cohort vs. the non-cirrhosis cohort (all P < 0.05). In subgroup analysis, compensated cirrhotic patients (n = 1308) had a similar adverse event profile to non-cirrhotic controls except for a slightly higher rate of PEP (7.7% vs. 5.5%; P < 0.05). However, decompensated cirrhotic patients (n = 622) had statistically significant higher rates of PEP (9.7% vs. 5.5%) and bleeding (4.3% vs. 1.0%), compared with non-cirrhotic controls respectively (P < 0.05). In regard to cirrhosis-related adverse events, cirrhotic patients undergoing ERCP were more likely to develop bacterial peritonitis vs. cirrhotic patients undergoing non-pancreaticobiliary endoscopy (2.2% vs. 1.1%; P < 0.005).

ERCP adverse events were statistically higher among patients with decompensated cirrhosis. This increased risk needs to be confirmed with prospective studies. A thorough risk/benefit assessment should be performed prior to performing ERCP in decompensated cirrhotic patients.