Endoscopic retrograde cholangiopancreatography in cirrhosis-a systematic review and meta-analysis focused on adverse events

• 作者: Ali A Siddiqui Amaninder Singh Dhaliwal Banreet Dhindsa Douglas G Adler Gordon Ohning Harlan Sayles Ji Won Yoo Mohit Girotra Qing Wu Shailender Singh Mashiana
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: META-ANALYSIS endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY Systematic review ADVERSE events CIRRHOSIS
• 年，卷（期）: 2018,（11）
• 页码范围: 354-366
• 页数: 13页
• 分类号: R

摘要

AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography(ERCP)in cirrhotics,especially adverse events.Patients with cirrhosis undergoing ERCP are believed to have increased risk.However,there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis,especially focusing on adverse events.METHODS We performed a systematic appraisal of major literature databases,including Pubmed and Embase,with a manual search of literature from their inception until April 2017.RESULTS A total of 6,505 patients from 15 studies were analyzed(male ratio 59%,mean age 59 years),11%with alcoholic and 89%with non-alcoholic cirrhosis,with 56.2%Child-Pugh class A,and 43.8%class B or C.Indications for ERCP included choledocholithiasis 60.9%,biliary strictures 26.2%,gallstone pancreatitis 21.1%and cholangitis 15.5%.Types of interventions included endoscopic sphincterotomy 52.7%,biliary stenting 16.7%and biliary dilation 4.6%.Individual adverse events included hemorrhage in 4.58%(95%CI:2.77-6.75%,I 2=85.9%),post-ERCP pancreatitis(PEP)in 3.68%(95%CI:1.83-6.00%,I 2=89.5%),cholangitis in 1.93%(95%CI:0.63-3.71%,I 2=87.1%)and perforation in 0.00%(95%CI:0.00-0.23%,I 2=37.8%).Six studies were used for comparison of ERCPrelated complications in cirrhosis vs non-cirrhosis,which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63(95%CI:1.27-2.09,I 2=65%):higher rates of hemorrhage with OR of 2.05(95%CI:1.62-2.58,I 2=2.1%)and PEP with OR of 1.33(95%CI:1.04-1.70,I 2=65%),but similar cholangitis rates with OR of 1.23(95%CI:0.67-2.26,I 2=44.3%).CONCLUSION There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis,especially hemorrhage and PEP.A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis.