Comparative study on safety of endoscopic retrograde cholangiopancreatography in patients with cirrhosis

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with cirrhosis. Methods A retrospective analysis was performed on the clinical data of 347 patients who were admitted to Beijing You'an Hospital and received ERCP from January 2010 to November 2013. Patients were divided into three groups: patients without liver diseases (n = 258) , patients with chronic hepatitis (n = 40) , and patients with cirrhosis (n = 49) . One-way ANOVA or Kruskal-Wallis H test was performed to compare changes in alanine aminotransferase (ALT) , aspartate transaminase (AST) , albumin (Alb) , total bilirubin (TBil) , white blood cells (WBC) , percentage of neutrophils (NEUT) , and serum amylase between the three groups of patients after ERCP. The incidence rates of complications, including hyperamylasemia, acute pancreatitis, infection, hemorrhage, and perforation, and distribution of disease spectrum diagnosis the changes in liver function and blood amylase after ERCP were analyzed compared between the three groups using chi-square test. Results Patients with cirrhosis had significantly lower levels of serum Alb, ALT, and AST than patients in the other two groups before ERCP (H = 3. 68, P = 0. 028; H = 14. 03, P = 0. 001, and H = 8. 00, P = 0. 018, respectively) . After ERCP, the TBil level was significantly higher in the cirrhosis group than in the other two groups (H = 6. 69, P = 0. 035) . Compared with the serum levels of AST and TBil before ERCP, 44. 9% (22 /49) of patients with cirrhosis had higher levels of AST and TBil 3 days after ERCP, the incidence of which was the highest among all three groups. The percentage of NEUT 1 day after ERCP in patients with cirrhosis was 73. 9% ± 12. 7%, which was similar to that in patients without liver diseases (74. 8% ± 11. 0%) and higher than that in patients with chronic hepatitis; the difference between the three groups was statistically significant (H = 7. 31, P = 0. 026) . Although no significant difference in the percentage of patients who had > 80%NEUT 3 days after ERCP was observed between the three groups, the percentage was the highest in the group of patients with cirrhosis (18. 4%, 9 /258) . The incidence rate of hyperamylasemia 24 hours after ERCP 24 h was significantly higher in patients with cirrhosis (53. 1%) than in patients without liver diseases (31. 8%) or with chronic hepatitis (40. 0%) (χ2= 8. 48, P = 0. 014) . The overall complication rates in patients with cirrhosis (18. 4%) was significantly higher than that in patients without liver diseases (8. 1%) or with chronic hepatitis (7. 5%) (χ2= 26. 73, P < 0. 001) . Conclusion ERCP is a safe and effective therapeutic intervention and well tolerated by patients with cirrhosis. Hyperamylasemia should be closely monitored after ERCP.