Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: Analysis of Trends and Outcomes From the National Inpatient Sample Database.

Autor:	Solanki S; Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton., Kichloo A; Departments of Medicine.; Department of Medicine, Central Michigan University College of Medicine, Saginaw., Dahiya DS; Department of Medicine, Central Michigan University College of Medicine, Saginaw., Solanki D; Department of Public Health, Rutgers University, New Brunswick, NJ., Singh J; Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton., Wani F; Family Medicine, Samaritan Medical Center, Watertown, NY., Albosta M; Department of Medicine, Central Michigan University College of Medicine, Saginaw., Ghimire S; Hospitalist Department., Haq KF; Department of Gastroenterology, Henry Ford Hospital, Detroit, MI., Khan HMA; Department of Gastroenterology, Guthrie Robert Packer Hospital, Sayre, PA., Jafri SM; Department of Gastroenterology, Henry Ford Hospital, Detroit, MI., Siddiqui MA; Department of Gastroenterology, Henry Ford Hospital, Detroit, MI., Zuchelli T; Department of Gastroenterology, Henry Ford Hospital, Detroit, MI.
Jazyk:	angličtina
Zdroj:	Journal of clinical gastroenterology [J Clin Gastroenterol] 2022 Aug 01; Vol. 56 (7), pp. 618-626. Date of Electronic Publication: 2021 Jun 09.
DOI:	10.1097/MCG.0000000000001573
Abstrakt:	Goals: We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis. Background: ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis. Study: Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes. Results: A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P <0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P <0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P <0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P <0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P <0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P <0.0001) but lower incidences of perforation and cholecystitis (0.1% vs. 0.3%; P <0.0001) and cholecystitis (1.9 vs. 3.1%; P <0.0001) compared with those who received diagnostic ERCP. Conclusions: Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed. (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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