THE SAFETY AND CLINICAL OUTCOMES OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH COMPENSATED AND DECOMPENSATED CIRRHOSIS: A RETROSPECTIVE MATCHED COHORT STUDY
DDW ePoster Library. Youssef M. 05/02/26; 4206282; Sp190
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Abstract
Discussion Forum (0)
Introduction:
Endoscopic Retrograde Cholangiopancreatography (ERCP) carries serious adverse events, including Gastrointestinal (GI) bleeding which may occur after endoscopic biliary and/or pancreatic sphincterotomy. However, the safety of performing ERCP in cirrhotic patients remains underexplored. In this study we aim to assess the adverse events of ERCP among patients with compensated and non-compensated cirrhosis compared with their matched non-cirrhotic controls.
Methods:
A retrospective comparative cohort study was conducted using the TriNetX database. CPT© codes were utilized to identify patients who underwent ERCP with sphincterotomy. Patients were then stratified into three groups (compensated, decompensated cirrhosis, and non-cirrhotic controls). Propensity score matching (PSM) (1:1) was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 7 days of the procedure. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs)were calculated for each outcome.
Results:
A total of 10,874 patients (mean age 61.4 ± 14.6 years) were included in the compensated cirrhosis cohort and were matched to10,874 non-cirrhotic controls, while 9,718 (59.1 ± 12.9 years) patients with decompensated cirrhosis were matched to 9,718 non-cirrhotic controls. (table 1,2)
When compared to matched controls, patients with compensated cirrhosis undergoing ERCP with sphincterotomy had a higher risk of GI bleeding, (aOR 1.21, 95% CI:1.00–1.4, P = 0.050), meanwhile it was more pronounced in the decompensated cohort, (aOR 1.3, 95%CI 1.10–1.53, p = 0.004) (table 3) (Fig 1). Subgroup analysis for patients who had platelet count more than 100k, revealed no increased bleeding risk in either compensated or decompensated cirrhosis groups (2.1% vs 1.8%, aOR: 1.17, 95% CI: 0.95,1.46, P= 0.14) and (2.803% vs 2.603%, aOR: 0.883-1.314, P= 0.4654) respectively.
Compared to matched controls, both compensated and decompensated cohorts had higher rates of ICU admission post ERCP: (aOR 1.339, 95% 1.144–1.567, P < 0.001) and (aOR 1.831 95%: 1.625–2.062, P < 0.001) respectively.
The 7-day mortality survival analysis showed that patients with compensated cirrhosis had no increased risk of mortality (HR: 0.974 95% CI: 0.694–1.366 p = 0.551), while decompensated cirrhosis group had higher mortality rates (HR 1.773 95% CI:1.376–2.285, P = 0.002)
Discussion:
In this real-world matched comparative analysis, overall compensated and decompensated cirrhotic patients who underwent ERCP with sphincterotomy had a higher risk of GI bleeding compared with non-cirrhotic controls. However, this risk diminished in both groups when platelet count exceeded 100k. This highlights the importance of enhanced precautions and individualized ERCP planning of patients with cirrhosis.
Endoscopic Retrograde Cholangiopancreatography (ERCP) carries serious adverse events, including Gastrointestinal (GI) bleeding which may occur after endoscopic biliary and/or pancreatic sphincterotomy. However, the safety of performing ERCP in cirrhotic patients remains underexplored. In this study we aim to assess the adverse events of ERCP among patients with compensated and non-compensated cirrhosis compared with their matched non-cirrhotic controls.
Methods:
A retrospective comparative cohort study was conducted using the TriNetX database. CPT© codes were utilized to identify patients who underwent ERCP with sphincterotomy. Patients were then stratified into three groups (compensated, decompensated cirrhosis, and non-cirrhotic controls). Propensity score matching (PSM) (1:1) was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 7 days of the procedure. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs)were calculated for each outcome.
Results:
A total of 10,874 patients (mean age 61.4 ± 14.6 years) were included in the compensated cirrhosis cohort and were matched to10,874 non-cirrhotic controls, while 9,718 (59.1 ± 12.9 years) patients with decompensated cirrhosis were matched to 9,718 non-cirrhotic controls. (table 1,2)
When compared to matched controls, patients with compensated cirrhosis undergoing ERCP with sphincterotomy had a higher risk of GI bleeding, (aOR 1.21, 95% CI:1.00–1.4, P = 0.050), meanwhile it was more pronounced in the decompensated cohort, (aOR 1.3, 95%CI 1.10–1.53, p = 0.004) (table 3) (Fig 1). Subgroup analysis for patients who had platelet count more than 100k, revealed no increased bleeding risk in either compensated or decompensated cirrhosis groups (2.1% vs 1.8%, aOR: 1.17, 95% CI: 0.95,1.46, P= 0.14) and (2.803% vs 2.603%, aOR: 0.883-1.314, P= 0.4654) respectively.
Compared to matched controls, both compensated and decompensated cohorts had higher rates of ICU admission post ERCP: (aOR 1.339, 95% 1.144–1.567, P < 0.001) and (aOR 1.831 95%: 1.625–2.062, P < 0.001) respectively.
The 7-day mortality survival analysis showed that patients with compensated cirrhosis had no increased risk of mortality (HR: 0.974 95% CI: 0.694–1.366 p = 0.551), while decompensated cirrhosis group had higher mortality rates (HR 1.773 95% CI:1.376–2.285, P = 0.002)
Discussion:
In this real-world matched comparative analysis, overall compensated and decompensated cirrhotic patients who underwent ERCP with sphincterotomy had a higher risk of GI bleeding compared with non-cirrhotic controls. However, this risk diminished in both groups when platelet count exceeded 100k. This highlights the importance of enhanced precautions and individualized ERCP planning of patients with cirrhosis.
Introduction:
Endoscopic Retrograde Cholangiopancreatography (ERCP) carries serious adverse events, including Gastrointestinal (GI) bleeding which may occur after endoscopic biliary and/or pancreatic sphincterotomy. However, the safety of performing ERCP in cirrhotic patients remains underexplored. In this study we aim to assess the adverse events of ERCP among patients with compensated and non-compensated cirrhosis compared with their matched non-cirrhotic controls.
Methods:
A retrospective comparative cohort study was conducted using the TriNetX database. CPT© codes were utilized to identify patients who underwent ERCP with sphincterotomy. Patients were then stratified into three groups (compensated, decompensated cirrhosis, and non-cirrhotic controls). Propensity score matching (PSM) (1:1) was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 7 days of the procedure. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs)were calculated for each outcome.
Results:
A total of 10,874 patients (mean age 61.4 ± 14.6 years) were included in the compensated cirrhosis cohort and were matched to10,874 non-cirrhotic controls, while 9,718 (59.1 ± 12.9 years) patients with decompensated cirrhosis were matched to 9,718 non-cirrhotic controls. (table 1,2)
When compared to matched controls, patients with compensated cirrhosis undergoing ERCP with sphincterotomy had a higher risk of GI bleeding, (aOR 1.21, 95% CI:1.00–1.4, P = 0.050), meanwhile it was more pronounced in the decompensated cohort, (aOR 1.3, 95%CI 1.10–1.53, p = 0.004) (table 3) (Fig 1). Subgroup analysis for patients who had platelet count more than 100k, revealed no increased bleeding risk in either compensated or decompensated cirrhosis groups (2.1% vs 1.8%, aOR: 1.17, 95% CI: 0.95,1.46, P= 0.14) and (2.803% vs 2.603%, aOR: 0.883-1.314, P= 0.4654) respectively.
Compared to matched controls, both compensated and decompensated cohorts had higher rates of ICU admission post ERCP: (aOR 1.339, 95% 1.144–1.567, P < 0.001) and (aOR 1.831 95%: 1.625–2.062, P < 0.001) respectively.
The 7-day mortality survival analysis showed that patients with compensated cirrhosis had no increased risk of mortality (HR: 0.974 95% CI: 0.694–1.366 p = 0.551), while decompensated cirrhosis group had higher mortality rates (HR 1.773 95% CI:1.376–2.285, P = 0.002)
Discussion:
In this real-world matched comparative analysis, overall compensated and decompensated cirrhotic patients who underwent ERCP with sphincterotomy had a higher risk of GI bleeding compared with non-cirrhotic controls. However, this risk diminished in both groups when platelet count exceeded 100k. This highlights the importance of enhanced precautions and individualized ERCP planning of patients with cirrhosis.
Endoscopic Retrograde Cholangiopancreatography (ERCP) carries serious adverse events, including Gastrointestinal (GI) bleeding which may occur after endoscopic biliary and/or pancreatic sphincterotomy. However, the safety of performing ERCP in cirrhotic patients remains underexplored. In this study we aim to assess the adverse events of ERCP among patients with compensated and non-compensated cirrhosis compared with their matched non-cirrhotic controls.
Methods:
A retrospective comparative cohort study was conducted using the TriNetX database. CPT© codes were utilized to identify patients who underwent ERCP with sphincterotomy. Patients were then stratified into three groups (compensated, decompensated cirrhosis, and non-cirrhotic controls). Propensity score matching (PSM) (1:1) was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 7 days of the procedure. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs)were calculated for each outcome.
Results:
A total of 10,874 patients (mean age 61.4 ± 14.6 years) were included in the compensated cirrhosis cohort and were matched to10,874 non-cirrhotic controls, while 9,718 (59.1 ± 12.9 years) patients with decompensated cirrhosis were matched to 9,718 non-cirrhotic controls. (table 1,2)
When compared to matched controls, patients with compensated cirrhosis undergoing ERCP with sphincterotomy had a higher risk of GI bleeding, (aOR 1.21, 95% CI:1.00–1.4, P = 0.050), meanwhile it was more pronounced in the decompensated cohort, (aOR 1.3, 95%CI 1.10–1.53, p = 0.004) (table 3) (Fig 1). Subgroup analysis for patients who had platelet count more than 100k, revealed no increased bleeding risk in either compensated or decompensated cirrhosis groups (2.1% vs 1.8%, aOR: 1.17, 95% CI: 0.95,1.46, P= 0.14) and (2.803% vs 2.603%, aOR: 0.883-1.314, P= 0.4654) respectively.
Compared to matched controls, both compensated and decompensated cohorts had higher rates of ICU admission post ERCP: (aOR 1.339, 95% 1.144–1.567, P < 0.001) and (aOR 1.831 95%: 1.625–2.062, P < 0.001) respectively.
The 7-day mortality survival analysis showed that patients with compensated cirrhosis had no increased risk of mortality (HR: 0.974 95% CI: 0.694–1.366 p = 0.551), while decompensated cirrhosis group had higher mortality rates (HR 1.773 95% CI:1.376–2.285, P = 0.002)
Discussion:
In this real-world matched comparative analysis, overall compensated and decompensated cirrhotic patients who underwent ERCP with sphincterotomy had a higher risk of GI bleeding compared with non-cirrhotic controls. However, this risk diminished in both groups when platelet count exceeded 100k. This highlights the importance of enhanced precautions and individualized ERCP planning of patients with cirrhosis.
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