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.