Early Hepatic Decompensation after ERCP in Patients with Cirrhosis: A Single‑center Retrospective Cohort Study

Patients with cirrhosis frequently require endoscopic retrograde cholangiopancreatography (ERCP), yet the burden of early hepatic decompensation after ERCP remains insufficiently characterized.

We conducted a single-center retrospective cohort study including 67 adults with established cirrhosis who underwent therapeutic ERCP between January 2021 and December 2023. Hepatic decompensation events [ascites, hepatorenal syndrome/acute kidney injury (HRS-AKI), hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis] were assessed before ERCP and at 72 hours post-procedure during index admission. Ascites was systematically evaluated by ultrasound in all patients. Paired changes in Child-Pugh points and MELD-Na were analyzed using Wilcoxon signed-rank tests and paired categorical outcomes using exact McNemar tests. Predictors of post-ERCP decompensation were explored using univariable logistic regression followed by a reduced exploratory multivariable model.

Mean age was 65.2±11.0 years and 73.1% were male. Child-Pugh class A/B/C distribution was 19/35/13, with a median model for end-stage liver disease sodium (MELD-Na) of 13.0 [9.5-16.5]. Any hepatic decompensation was present in 23.9% of patients before ERCP and increased to 44.8% at 72 hours. Child-Pugh points increased from 7 (6-9) to 8 (7-9.5) (p<0.001), and MELD-Na from 13 (9.25-16.75) to 15 (10.00-18.00) (p<0.001). Ascites (23.9% to 38.8%, p=0.006) and HRS-AKI (1.5% to 10.4%, p=0.031) increased significantly. Baseline Child-Pugh score remained independently associated with 72-hour decompensation after adjustment for baseline decompensation status.

Early new or worsening hepatic decompensation within 72 hours after ERCP is frequent in patients with cirrhosis. Baseline liver severity should inform peri-procedural risk stratification and early post-procedure monitoring.