PLoS ONE (Jan 2018)

Risk of endoscopic biliary interventions in primary sclerosing cholangitis is similar between patients with and without cirrhosis.

  • Moritz Peiseler,
  • David Reiners,
  • Hans O Pinnschmidt,
  • Marcial Sebode,
  • Franziska Jung,
  • Johannes Hartl,
  • Roman Zenouzi,
  • Hanno Ehlken,
  • Stefan Groth,
  • Guido Schachschal,
  • Thomas Rösch,
  • Christina Weiler-Normann,
  • Ansgar W Lohse,
  • Christoph Schramm

DOI
https://doi.org/10.1371/journal.pone.0202686
Journal volume & issue
Vol. 13, no. 8
p. e0202686

Abstract

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BACKGROUND:Endoscopic retrograde cholangiography (ERC) is a mainstay of therapy in patients with primary sclerosing cholangitis (PSC) and obstructive cholestasis. Patients with liver cirrhosis have an increased risk of surgical complications and are more susceptible to infections. Since PSC often progresses to cirrhosis, we aimed to assess whether ERC is associated with increased risk of complications in patients with PSC and cirrhosis. METHODS:Out of 383 patients with PSC, 208 patients received endoscopic treatment between 2009-2017. Seventy patients had cirrhosis when ERC was performed and 138 patients had no signs of cirrhosis. Overall, 663 ERC procedures were analysed, with 250 ERC in patients with cirrhosis and 413 ERC in patients without cirrhosis. Data were analysed retrospectively from a prospectively acquired database using repeated measures logistic regression. RESULTS:Overall, 40 procedure-related complications were documented in 663 ERC interventions (6%). The rate of complications was similar between patients with and without cirrhosis (4.4% vs. 7.0%). First-time ERC was associated with a higher risk of complications (17.5% vs. 4.9%). Biliary sphincterotomy, stent placement and female sex, but not presence of liver cirrhosis, were identified as risk factors for overall complications in multivariate analysis. Patients without cirrhosis showed a significant decline of ALP and bilirubin levels after the first two interventions. In contrast, in patients with cirrhosis, ALP and bilirubin levels did not significantly decline after ERC. CONCLUSIONS:In patients with PSC, cirrhosis was not a risk factor for post-ERC complications. Therefore, cirrhosis should not preclude endoscopic intervention in patients with clear clinical indication.