Chronic liver disease ups risk of post-ERCP complications

Endoscopic retrograde cholangiopancreatography (ERCP), although deemed safe, is associated with the highest risk of complications when compared with other endoscopic procedures, reveals a study.

“As a result, risk stratification is crucial,” the authors said. “Certain demographics, conditions like end-stage renal disease, liver cirrhosis, and procedural factors have been identified as risk factors for post-ERCP complications.”

A total of 883,825 patients who underwent ERCP between 2016 and 2019 were identified using the National Inpatient Sample database and were stratified into two group: those with chronic liver disease (CLD) and those without CLD.

The rate of post-ERCP pancreatitis, post-ERCP haemorrhage, and perforation between the two groups were the primary outcomes. Other outcomes assessed included in-hospital mortality and length of stay. Finally, the authors estimated the association between CLD and ERCP outcomes using a multivariate regression model.

Of the patients, 21,212 (2.4 percent, mean age 61.66 years) had CLD and 862,613 (97.6 percent, mean age 60.46 years) had no CLD.

The cohort with CLD showed higher rates of post-ERCP pancreatitis (8.8 percent vs 6.7 percent; adjusted odds ratio [aOR], 1.3; p<0.001) and post-ERCP haemorrhage (8.8 percent vs 6.69 percent; aOR, 1.35; p<0.001). No significant between-group difference was noted in the rate of post-procedure perforation.

Likewise, in-hospital mortality (3.03 percent vs 1.58 percent; p<0.001) and length of stay (7 vs 3 days; p<0.001) were higher in patients with CLD.

“Our study represents newer data, with use of revised ICD codes, to demonstrate increased risk in patients with liver disease,” the authors said. “ERCP should be used judiciously in this population, and further studies are required for identifying reversible risk factors to improve outcomes.”