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

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%; I(2)=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%–7.2%; I(2)=91.5%), bleeding 3.6% (95% CI, 2.8%–4.5%; I(2)=67.5%), cholangitis 2.9% (95% CI, 1.9%–3.8%; I(2)=83.4%), and perforation 0.3% (95% CI, 0.1%–0.5%; I(2)=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16–1.71; I(2)=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; I(2)=24.8%), bleeding (RR, 1.94; 95% CI, 1.59–2.37; I(2)=0%), cholangitis (RR, 1.15; 95% CI, 0.77–1.70; I(2)=12%), and perforation (RR, 1.20; 95% CI, 0.59–2.43; I(2)=0%). CONCLUSIONS: Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.