Goals: 

We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis.

Background: 

ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis.

Study: 

Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes.

Results: 

A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P<0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P<0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P<0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P<0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P<0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P<0.0001) but lower incidences 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.

Conclusions: 

Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed.

中文翻译：

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肝硬化患者的内镜逆行胰胆管造影 (ERCP)：国家住院患者样本数据库的趋势和结果分析

目标： 

我们的目的是评估接受治疗性或诊断性内镜逆行胰胆管造影（ERCP）的肝硬化患者的结局，以确定这些患者相对于非肝硬化患者是否有不同的结局。

背景： 

ERCP 是治疗胆胰疾病的重要手术。然而，与食管胃十二指肠镜检查或结肠镜检查等手术相比，ERCP 在技术上相对困难。关于 ERCP 的使用如何影响肝硬化患者知之甚少。

学习： 

我们利用国家住院样本 (NIS) 数据库中的患者记录，使用国际疾病分类、第九版编码和分层数据，确定了 2009 年至 2014 年间接受 ERCP 的成年患者，并将数据分为 2 组：肝硬化患者和非肝硬化患者。我们比较了各组之间的基线特征和多种结果，并比较了肝硬化患者诊断性 ERCP 与治疗性 ERCP 的结果。使用多变量回归模型来估计肝硬化与 ERCP 结果的关联。

结果： 

2009年至2014年间，共有1,038,258例接受ERCP住院的患者被确定，其中31,294例患有肝硬化，994,681例没有肝硬化。在肝硬化患者中，21,835 名（69.8%）接受了治疗性 ERCP，9459 名（30.2%）接受了诊断性 ERCP。与非肝硬化患者相比，肝硬化患者 ERCP 相关出血较多（2.5% vs. 1.2%；P <0.0001），但穿孔发生率较低（0.1% vs. 0.2%；P <0.0001）和 ERCP 后胰腺炎（8.6 % 与 7%；P <0.0001）。各组之间的胆囊炎相同（2.3% vs. 2.3%；P <0.0001）。在肝硬化患者中，接受治疗性 ERCP 的患者术后胰腺炎（7.9% vs. 5.1%；P <0.0001）和 ERCP 相关出血（2.7% vs. 2.1%；P <0.0001）的发生率较高，但穿孔发生率较低与接受诊断性 ERCP 的患者相比，胆囊炎（0.1% vs. 0.3%；P <0.0001）和胆囊炎（1.9% vs. 3.1%；P <0.0001）。

结论： 

在肝硬化患者中使用治疗性 ERCP 可能会导致胰腺炎和术后出血等并发症的风险增加，而诊断性 ERCP 可能会增加肝硬化患者患胰腺炎和胆囊炎的风险。肝硬化患者的合并症可能会增加 ERCP 术后并发症和死亡的风险；因此，应仔细考虑在肝硬化患者中使用ERCP，并需要对该患者群体进行进一步研究。