title: Endoscopic management of choledocholithiasis and cholelithiasis in patients with cirrhosis.
abstract: Treatment of choledocholithiasis and cholelithiasis in patients with cirrhosis often requires diagnostic and therapeutic endoscopy such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Patients with underlying cirrhosis may have coagulopathy, hepatic encephalopathy, ascites and other comorbidities associated with cirrhosis that can make endoscopic therapy challenging and can be associated with a higher risk of adverse events. Given the unique derangements of physiologic parameters associated with cirrhosis this population requires a truly multifaceted and multidisciplinary understanding between therapeutic endoscopists, hepatologists and anesthesiologists. For therapeutic endoscopists, it is critical to be aware of the specific issues unique to this population of patients to optimize outcomes and avoid adverse events. The epidemiology of gallstone disease, the diagnostic and therapeutic approach to patients with varying degree of hepatic dysfunction, and a review of the available literature in this area are presented.
authors.affiliation: a Digestive and Liver Diseases , Columbia University Medical Center , New York , NY , USA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Khan
authors.affiliation: b Anniston Digestive Health , Anniston , AL , USA.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.affiliation: c Division of Gastroenterology and Hepatology , The Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019160:Endosonography; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000493:pharmacokinetics; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives
keywords: Ascites; Choledocholithiasis; Cholelithiasis; EUS; MRCP