For a study, researchers sought to determine whether or not patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) had outcomes that were distinct from those of patients who did not have cirrhosis. Investigators identified adult patients who had undergone ERCP between 2009 and 2014 using the International Classification of Disease, Ninth Revision coding. They then stratified the data into 2 groups: patients who had liver cirrhosis and those who did not have liver cirrhosis. Patient records were obtained from the National Inpatient Sample (NIS) database. They compared the outcomes of diagnostic ERCP to those of therapeutic ERCP.  A total of 1,038,258 hospitalizations of patients who had undergone ERCP between 2009 and 2014 were detected, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. The study period was from 2009 to 2014. There were 21,835 patients with cirrhosis treated with therapeutic ERCP (which accounts for 69.8%), and there were 9,459 patients treated with diagnostic ERCP (which accounts for 30.2%). Patients with cirrhosis exhibited a higher frequency of ERCP-associated hemorrhages (2.5% vs. 1.2%; P<0.0001), although they had a lower incidence of perforations (0.1% vs. 0.2%; P<0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P<0.0001) than patients without cirrhosis. Cholecystitis occurred in the same proportion of patients in both groups (2.3% vs. 2.3%; P<0.0001). Patients diagnosed with cirrhosis who underwent therapeutic ERCP had a higher incidence of post-ERCP pancreatitis (7.9% vs. 5.1%; P<0.0001) and ERCP-associated bleeding (2.7% vs. 2.1%; P<0.0001), but a lower incidence 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. Using therapeutic ERCP in patients with liver cirrhosis might lead to a higher risk of complications such as pancreatitis and post-procedure bleeding. On the other hand, the use of diagnostic ERCP in patients with cirrhosis may raise the risk of pancreatitis and cholecystitis. Comorbidities in patients with cirrhosis might increase the risk of post-ERCP complications and mortality; as a result, the use of ERCP in patients with cirrhosis was carefully addressed, and additional research on this patient population was required.

Source – journals.lww.com/jcge/Fulltext/2022/08000/Endoscopic_Retrograde_Cholangiopancreatography.11.aspx