title: Risk factors associated with complications in cirrhotic patients undergoing endoscopic retrograde cholangio-pancreatography.
abstract: OBJECTIVE
  Endoscopic retrograde cholangio-pancreatography (ERCP) is useful for the management of biliary tract diseases; in patients with cirrhosis, portal hypertension may increase the risk for complications from ERCP. We evaluated the outcome and risk factors related to ERCP in patients with cirrhosis and portal hypertension.
  
  
  METHODS
  In this case-control study, 37 patients (71 procedures) with cirrhosis and portal hypertension (group 1) and 37 controls (group 2) undergoing ERCP were included. Logistic regression and receiver operating characteristic curve analysis were used to predict the risk factors.
  
  
  RESULTS
  Mean Child-Pugh and model for end-stage liver disease (MELD) score were 9±2.1 and 17.8±6, respectively. Ascites was present in 46% of the patients, esophageal varices in 63% (large esophageal varices 43.7%), and hepatic encephalopathy in 16%. The main indication for ERCP in both groups was choledocholithiasis. Successful cannulation rate was 97% in both groups. Biliary sphincterotomy was performed more frequently in group 2 than in group 1 (60 vs. 35%, P=0.036); there was no difference in the frequency of complications related to ERCP between cirrhotics and noncirrhotics (10 vs. 8%, P=0.677). Complications in patients with cirrhosis were related to lower alkaline phosphatase and sphincterotomy rate; in the multivariable analysis only sphincterotomy was independently associated with complications [odds ratio 9.8 (1.7-56.3)]. Receiver operating characteristic curve analysis yielded a MELD score of more than 16 to best predict complications after ERCP in cirrhosis.
  
  
  CONCLUSIONS
  Outcomes after ERCP in patients with cirrhosis are similar to those of noncirrhotics despite the alteration in coagulation parameters and the presence of disease-specific complications; however, a more cautious approach in patients with cirrhosis undergoing sphincterotomy and MELD of more than 16 is needed.
authors.affiliation: aDepartment of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran', Mexico City, Mexico bDepartment of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany cDivision of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ricardo U
authors.initials: RU
authors.lastname: Macías-Rodríguez
authors.forename: Astrid
authors.initials: A
authors.lastname: Ruiz-Margáin
authors.forename: Jose L
authors.initials: JL
authors.lastname: Rodriguez-Garcia
authors.forename: Sergio
authors.initials: S
authors.lastname: Zepeda-Gómez
authors.forename: Aldo
authors.initials: A
authors.lastname: Torre
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D058625:End Stage Liver Disease; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000706:statistics & numerical data*