Michelle Bernshteyn, MD, Linda Hu, BS, Umair Masood, MD, Danning Huang, MS, MA, Bishnu Sapkota, MD, FACG; SUNY Upstate Medical University, Syracuse, NY
Introduction: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is a commonly performed gastrointestinal procedure. There is minimal objective data regarding adverse events related to ERCP in patients with cirrhosis compared to those without cirrhosis and even fewer data comparing complications among cirrhotics patients based on severity of cirrhosis. The primary aim of our study is to determine if patients with cirrhosis are at increased risk of adverse events related to ERCP mainly pancreatitis, bleeding, perforation, cholangitis, and mortality. The secondary aim is to see if higher Child-Pugh (CP) score and Model for End-Stage Liver Disease (MELD) score are associated with higher post ERCP complications. Methods: This was a retrospective study including 174 patients with cirrhosis and 518 without cirrhosis, who underwent ERCP at a University hospital from 2012-2019. Charts were reviewed. MELD and CP Score were calculated. Demographics, co-morbidities, cirrhosis etiology, indication, type of anesthesia, intervention, and complications within a 30-day period were analyzed. Results: Average age of patients was 58.6 years. Overall complications were higher in cirrhotics compared to non-cirrhotics (p-value 0.015 at significant level of 0.05). There was no statistical significance comparing the specific complications across the two groups (p-value 0.897). CP score, especially CP C, was more reliable than MELD score in terms of complication in cirrhotics. CP C patients had more complications than CP A and CP B (p-value 0.010). MELD score < 15 versus >15 did not have statistically significant effect on complications in cirrhotics (p-value 0.949). In cirrhotics, Chronic Obstructive Pulmonary Disease (COPD) and Hypertension (HTN) demonstrated significantly higher rates of complications (p-values of 0.009 and 0.003 respectively). In non-cirrhotics, only COPD demonstrated a statistically significant difference (p-value 0.003). In “diagnosis-only” subgroup within non-cirrhotic patients, complications were more likely (p-value 0.039). Finally, etiology of cirrhosis nor type of anesthesia utilized during ERCP had statistical significance regarding complications. Discussion: Our study re-affirms that ERCP is associated with statistically significant complications in cirrhotic patients compared to those without cirrhosis. However, our study shows that CP score seems to be more reliable than MELD score in predicting complications of ERCP in cirrhotic patients.
Complication status and different types of complications in group of subjects with/without cirrhosis.
Child-Pugh Score of Cirrhosis patients (N=174) with or without any complication.
MELD score of Cirrhosis patients (N=174) with or without any complication.
Disclosures: Michelle Bernshteyn indicated no relevant financial relationships. Linda Hu indicated no relevant financial relationships. Umair Masood indicated no relevant financial relationships. Danning Huang indicated no relevant financial relationships. Bishnu Sapkota indicated no relevant financial relationships.