Safety, risk stratification, and cost of ERCP in patients with cirrhosis: a prospective controlled study

Abstract

Abstract Introduction Given that ERCP has major procedure-related complications in non-cirrhotic patients, the complications and the cost of therapeutic ERCP were not studied in cirrhotic patients. Aim We aimed to study the complications and cost of ERCP compared to patients without cirrhosis. Patients and methods Outcome and complications of therapeutic ERCP were prospectively studied in patients with cirrhosis and compared to patients without cirrhosis undergoing ERCP. Patients with cirrhosis were evaluated using the Child-Pugh classification, MELD, MELD Na, and APRI scores. Safety was assessed up to 30 days following the procedure. Results Pancreatitis, perforation, bleeding, and cardiopulmonary complications were not different in both groups (8% vs. 9.3, 0% vs. 2%, 3.3% vs. 4%, and 4% vs. 2% respectively), while cholangitis occurred more frequently in cirrhosis (13.3% vs. 1.3% respectively). Hospital stay was longer, and mortality and costs were significantly higher among patients with cirrhosis. Patients with Child C cirrhosis developed more complications and had higher mortality. A MELD score cut-off of ≥ 11.5 separated all mortalities. Similarly, MELD-Na and APRI separated patients with cirrhosis who had more frequent complications and mortalities. Conclusions Patients with cirrhosis experienced more complications and costs, and cirrhotic patients who developed moderate to severe complications were more likely to die.

Keywords

• ERCP
• Liver cirrhosis
• Cholangitis
• Obstructive jaundice
• Cost