PMID- 30177786 OWN - NLM STAT- MEDLINE DCOM- 20191112 LR - 20191112 IS - 1572-0241 (Electronic) IS - 0002-9270 (Linking) VI - 114 IP - 1 DP - 2019 Jan TI - Adverse Events and Acute Chronic Liver Failure in Patients With Cirrhosis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Multicenter Matched-Cohort Study. PG - 89-97 LID - 10.1038/s41395-018-0218-1 [doi] AB - BACKGROUND: Data on the outcome of adverse events (AEs) and the risk of developing acute-on-chronic liver failure (ACLF) after ERCP in patients with cirrhosis are unknown. We examined the incidence and risk factors of post-ERCP AEs in patients with cirrhosis and the appearance of ACLF after ERCP. METHODS: In this multicenter, retrospective, matched-cohort study, we evaluated ERCPs performed from January 2002 to 2015. A group of patients with cirrhosis with non-ERCP interventions and one without interventions was also analyzed for the development of ACLF. RESULTS: A total of 441 ERCPs were analyzed; 158 in patients with cirrhosis (cases) and 283 in patients without cirrhosis (controls). The overall rate of AEs after all ERCPs was significantly higher in cases compared to controls (17% vs 9.5, p = 0.02). Cholangitis developed more in cases compared to controls (6.3% vs 1.8%; p = 0.01). In a subanalysis of those with sphincterotomy, the rate of bleeding was higher in those with cirrhosis (9.4% vs 3.4%; p = 0.03). Logistic regression identified cirrhosis (OR, 2.48; 95% CI, 1.36-4.53; p = 0.003) and sphincterotomy (OR, 2.66; 95% CI, 1.23-5.72; p = 0.01) as risk factors of AEs. A total of 18/158 (11.4%) cases developed ACLF after ERCP. ACLF occurred in 7/27 cases with post-ERCP AEs and in 11/131 without post-ERCP AEs (25.9% vs 8.3%; p = 0.01). A total of 3.2% (13/406) patients without interventions developed ACLF compared to 17.5% (102/580) who developed ACLF after non-ERCP interventions. Patients with decompensated cirrhosis at ERCP had a higher risk of developing ACLF (17% vs 6.8%; p = 0.04). Patients with a MELD score >/= 15 were 3.1 times more likely (95% CI: 1.14-8.6; p = 0.027) to develop ACLF after ERCP. CONCLUSIONS: The rate of AEs after ERCP is higher in patients with cirrhosis compared to the non-cirrhotic population. The incidence of ACLF is higher in those with AEs after ERCP compared to those without AEs, especially cholangitis. The development of ACLF is common after ERCP and other invasive procedures. ACLF can be precipitated by numerous factors which include preceding events before the procedure, including manipulation of the bile duct, and AEs after an ERCP. FAU - Leal, Carles AU - Leal C AD - GI/Endoscopy Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. AD - Gastroenterology Department, Hospital Universitari de Vic, Barcelona, Spain. FAU - Prado, Veronica AU - Prado V AD - Liver Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. FAU - Colan, Juan AU - Colan J AD - Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca - IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Chavez-Rivera, Karina AU - Chavez-Rivera K AD - GI/Endoscopy Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. FAU - Sendino, Oriol AU - Sendino O AD - GI/Endoscopy Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. AD - Institut d'Investigacions Biomediques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepaticas y Digestivas (CIBEREHD), Barcelona, Spain. FAU - Blasi, Anabel AU - Blasi A AD - Anesthesiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain. FAU - Roura, Pere AU - Roura P AD - Gastroenterology Department, Hospital Universitari de Vic, Barcelona, Spain. FAU - Juanola, Adria AU - Juanola A AD - Liver Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. AD - Institut d'Investigacions Biomediques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepaticas y Digestivas (CIBEREHD), Barcelona, Spain. FAU - Rodriguez de Miguel, Cristina AU - Rodriguez de Miguel C AD - GI/Endoscopy Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. FAU - Pavesi, Marco AU - Pavesi M AD - European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain. FAU - Gomez, Cristina AU - Gomez C AD - Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca - IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Guarner, Carlos AU - Guarner C AD - Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca - IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Guarner-Argente, Carlos AU - Guarner-Argente C AD - Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca - IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Fernandez, Javier AU - Fernandez J AD - Liver Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. AD - Institut d'Investigacions Biomediques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepaticas y Digestivas (CIBEREHD), Barcelona, Spain. AD - European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain. FAU - Cardenas, Andres AU - Cardenas A AD - GI/Endoscopy Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. AD - Liver Unit. Institut de Malalties Digestives i Metaboliques, Hospital Clinic, University of Barcelona, Barcelona, Spain. AD - Institut d'Investigacions Biomediques August Pi-Sunyer (IDIBAPS) y Ciber de Enfermedades Hepaticas y Digestivas (CIBEREHD), Barcelona, Spain. LA - eng PT - Journal Article PT - Multicenter Study PL - United States TA - Am J Gastroenterol JT - The American journal of gastroenterology JID - 0421030 SB - IM CIN - Am J Gastroenterol. 2019 Jan;114(1):19-20. PMID: 30315309 MH - Aged MH - Cholangiopancreatography, Endoscopic Retrograde/adverse effects MH - Cohort Studies MH - End Stage Liver Disease/*epidemiology/etiology MH - Female MH - Humans MH - Liver Cirrhosis/*surgery MH - Male MH - Postoperative Complications/epidemiology/etiology MH - Retrospective Studies MH - Risk Factors MH - Spain/epidemiology EDAT- 2018/09/05 06:00 MHDA- 2019/11/13 06:00 CRDT- 2018/09/05 06:00 PHST- 2018/09/05 06:00 [pubmed] PHST- 2019/11/13 06:00 [medline] PHST- 2018/09/05 06:00 [entrez] AID - 10.1038/s41395-018-0218-1 [doi] PST - ppublish SO - Am J Gastroenterol. 2019 Jan;114(1):89-97. doi: 10.1038/s41395-018-0218-1.