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ERCP-Related Adverse Events in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis
Navneet Natt1, Faith Michael1, Hope Michael2
1Northern Ontario School of Medicine University, Sudbury and Thunder Bay, Ontario, Canada.
Canadian Journal of Gastroenterology & Hepatology
|August 1, 2022
Summary
Patients with primary sclerosing cholangitis (PSC) undergoing endoscopic retrograde cholangiopancreatography (ERCP) face a threefold increased risk of cholangitis. Accidental guidewire passage and biliary sphincterotomy are key risk factors for post-ERCP pancreatitis (PEP).
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Primary sclerosing cholangitis (PSC) is a chronic liver disease often managed with endoscopic retrograde cholangiopancreatography (ERCP).
- Conflicting data exists regarding ERCP-associated adverse events in PSC patients.
- This study aims to compare ERCP risks in PSC patients versus non-PSC patients and identify PSC-specific risk factors.
Purpose of the Study:
- To compare the incidence of ERCP-related adverse events (cholangitis, pancreatitis, bleeding, perforation) in patients with and without PSC.
- To identify specific risk factors for ERCP-related adverse events, particularly post-ERCP pancreatitis (PEP), in PSC patients.
Main Methods:
- A systematic review and meta-analysis of studies published between January 1, 2000, and May 12, 2021.
- Searched Embase, PubMed, and CENTRAL databases for eligible studies involving adults undergoing ERCP.
- Utilized random-effects models to pool odds ratios (ORs) for adverse events and risk factors, assessing risk of bias with established scales.
Main Results:
- Four studies meta-analyzed 715 PSC patients and 9979 non-PSC patients, revealing a significant threefold increase in 30-day cholangitis odds for PSC patients (OR 3.263).
- No significant differences were observed in post-ERCP pancreatitis, bleeding, or perforation rates between the groups.
- In a separate meta-analysis of five studies, accidental guidewire passage into the pancreatic duct (OR 7.444) and biliary sphincterotomy (OR 4.802) were significantly associated with increased PEP risk.
Conclusions:
- PSC patients undergoing ERCP exhibit a higher risk of cholangitis, even with antibiotic prophylaxis.
- Accidental guidewire manipulation and biliary sphincterotomy are identified as significant risk factors for post-ERCP pancreatitis.
- Further research is warranted to explore ERCP-related risks and develop effective preventive strategies in PSC management.
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