Efficacy and safety of therapeutic ERCP in patients with cirrhosis: a large multicenter study
Efficacy and safety of therapeutic ERCP in patients with cirrhosis: a large multicenter study
复制标题
DOI：
10.1016/j.gie.2015.08.022
复制
发表时间：
2016-02-01
影响因子：
7.7
通讯作者：
Siddiqui, Ali
中科院分区：
文献类型：
--
作者：
Adler, Douglas G.;Haseeb, Abdul;Siddiqui, Ali
背景和目标：肝硬化患者可能因为潜在的腹水、凝血障碍、脑病和其他问题而不是ERCP的最佳候选者。虽然肝硬化患者手术的风险是众所周知的，但关于肝硬化患者ERCP的数据很少。我们进行了一项回顾性，多中心研究ERCP在肝硬化患者，以评估结果，疗效和safety.Methods：多中心回顾性研究。结果：共538 ERCP程序进行了328例肝硬化患者。共有229例患者为Child-Pugh（CP）A级，229例患者为CP B级，80例患者为CP C级。ERCP前纠正血小板减少和凝血功能障碍。30天内与手术相关的不良事件包括ERCP术后胰腺炎（n = 25，4.6%：21例轻度，3例中度，1例重度），出血（n = 6，1.1%），胆管炎（n = 15，2.8%），穿孔（n = 2，0.4%）、吸入性肺炎（n = 5，0.9%）、胆漏（n = 1，0.2%）、胆囊炎（n = 1，0.2%）和死亡（n = 1，0.2%）。CP B级和C级疾病患者的不良事件发生率高于CP A级疾病患者（分别为11.4%、11.3%和6.1%; P = 0.048）。即使在接受括约肌切开术的患者中，显著出血的风险与凝血功能障碍或CP分级之间也没有相关性。控制不良的脑病与较高的总体不良事件发生率相关（P = .003）。亚组分析显示，没有原发性硬化性胆管炎的患者有一个显着更高的整体率的不良事件，胰腺炎，出血，心肺不良事件ERCP后相比，与原发性硬化性胆管炎。结论：我们的研究进行了一个大系列的肝硬化患者接受ERCP。总体而言，肝硬化患者中观察到的不良事件与接受ERCP的一般患者人群中观察到的不良事件相似，尽管CP B和C级患者的不良事件发生率高于CP A级患者。与原发性硬化性胆管炎患者相比，无原发性硬化性胆管炎的肝硬化患者的不良事件发生率明显更高。
Background and Aims: Patients with cirrhosis may be less than optimal candidates for ERCP because of underlying ascites, coagulopathy, encephalopathy, and other problems. Although the risks of surgery in patients with cirrhosis are well known, few data are available regarding ERCP in patients with cirrhosis. We performed a retrospective, multicenter study of ERCP in patients with cirrhosis to evaluate outcomes, efficacy, and safety.Methods: Multicenter retrospective study.Results: A total of 538 ERCP procedures were performed on 328 patients with cirrhosis. A total of 229 patients had Child-Pugh (CP) class A, 229 patients had CP class B, and 80 patients had CP class C. Thrombocytopenia and coagulopathy were corrected before ERCP. The 30-day, procedure-related adverse events included post-ERCP pancreatitis (n = 25, 4.6%: 21 mild, 3 moderate, 1 severe), hemorrhage (n = 6, 1.1%), cholangitis (n = 15, 2.8%), perforation (n = 2, 0.4%), aspiration pneumonia (n = 5, 0.9%), bile leakage (n = 1, 0.2%), cholecystitis (n = 1, 0.2%), and death (n = 1, 0.2%). There was a higher incidence of adverse events in patients with CP class B and C disease when compared with those with CP class A disease (11.4%, 11.3%, and 6.1%, respectively; P = .048). There was no correlation between the risk of significant hemorrhage and the presence of coagulopathy or CP class, even in those who underwent a sphincterotomy. The presence of poorly controlled encephalopathy correlated with a higher overall adverse event rate (P = .003). Sub-analysis revealed that patients without primary sclerosing cholangitis had a significantly higher overall rate of adverse events, pancreatitis, bleeding, and cardiopulmonary adverse events after ERCP when compared with those with primary sclerosing cholangitis.Conclusions: Our study was performed on a large series of patients with cirrhosis undergoing ERCP. Overall, the adverse events seen in patients with cirrhosis are similar to those seen in the general population of patients undergoing ERCP, although patients with CP classes B and C have higher adverse event rates compared with those with CP class A. Patients with cirrhosis without primary sclerosing cholangitis had significantly greater adverse event rates when compared with patients with primary sclerosing cholangitis.