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KMID : 1038120230560050578
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Clinical Endoscopy
2023 Volume.56 No. 5 p.578 ~ p.589
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Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis
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Zahid Ijaz Tarar
Umer Farooq
Mustafa Gandhi
Saad Saleem
Ebubekir Daglilar
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Abstract
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Background/Aims : The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis.
Methods : We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis.
Results : Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%?19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%?7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%?4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%?3.8%; I2=83.4%), and perforation 0.3% (95% CI, 0.1%?0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16?1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06?1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59?2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77?1.70; I2=12%), and perforation (RR, 1.20; 95% CI, 0.59?2.43; I2=0%).
Conclusions : Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.
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KEYWORD
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Child-Pugh, Cholangitis, Cirrhosis, Endoscopic retrograde cholangiopancreatography, Hemorrhage, Pancreatitis
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