Safety of Endoscopy in Cirrhosis

Background Endoscopic procedures are among the most commonly performed medical procedures and the serious adverse event rate is reported to be 1–3 adverse events per 1000 procedures. Aims Here, we have examined the safety of endoscopy specifically in cirrhotic populations. Methods We conducted a retrospective case (cirrhosis)–control (non-cirrhosis) study of the outcomes of patients undergoing endoscopy in a large academic medical center. The primary outcome was a procedural or post-procedural complication. Complete clinical data were collected for all patients undergoing endoscopic procedures—including esophagogastroduodenoscopy, colonoscopy, EUS, ERCP, flexible sigmoidoscopy, and others. Cirrhosis was carefully defined based on clinico-pathological grounds. Results We identified 16,779 patients who underwent endoscopy, including 2618 with cirrhosis and 14,161 without cirrhosis. There were 167 complications (0.99%), which included 15/2618 cirrhotics (0.6%) and 152/14,161 (1.1%) non-cirrhotics. The most common complications were cardiopulmonary (including hypotension and hypoxemia) found in 67% of patients; procedurally related complications occurred in 19% of patients. The complication rate was the same or lower in cirrhotics than controls undergoing esophagogastroduodenoscopy (0.6% vs 0.9%, p = 0.03), colonoscopy (0.6% vs. 0.6%, p = NS), or ERCP (0.7% vs. 1.4%, p = NS) Logistic regression analysis identified the following features to be associated with an increased risk of having a complication: inpatient status, history of myocardial infarction, and an EUS procedure. Conclusions Endoscopy in cirrhotic patients was as safe or safer than non-cirrhotic patients undergoing similar procedures.