I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
PLoS One. 2018 Aug 20;13(8):e0202686. doi: 10.1371/journal.pone.0202686. eCollection 2018.
Endoscopic retrograde cholangiography (ERC) is a mainstay of therapy in patients with primary sclerosing cholangitis (PSC) and obstructive cholestasis. Patients with liver cirrhosis have an increased risk of surgical complications and are more susceptible to infections. Since PSC often progresses to cirrhosis, we aimed to assess whether ERC is associated with increased risk of complications in patients with PSC and cirrhosis.
Out of 383 patients with PSC, 208 patients received endoscopic treatment between 2009-2017. Seventy patients had cirrhosis when ERC was performed and 138 patients had no signs of cirrhosis. Overall, 663 ERC procedures were analysed, with 250 ERC in patients with cirrhosis and 413 ERC in patients without cirrhosis. Data were analysed retrospectively from a prospectively acquired database using repeated measures logistic regression.
Overall, 40 procedure-related complications were documented in 663 ERC interventions (6%). The rate of complications was similar between patients with and without cirrhosis (4.4% vs. 7.0%). First-time ERC was associated with a higher risk of complications (17.5% vs. 4.9%). Biliary sphincterotomy, stent placement and female sex, but not presence of liver cirrhosis, were identified as risk factors for overall complications in multivariate analysis. Patients without cirrhosis showed a significant decline of ALP and bilirubin levels after the first two interventions. In contrast, in patients with cirrhosis, ALP and bilirubin levels did not significantly decline after ERC.
In patients with PSC, cirrhosis was not a risk factor for post-ERC complications. Therefore, cirrhosis should not preclude endoscopic intervention in patients with clear clinical indication.
内镜逆行胰胆管造影术（ERC）是原发性硬化性胆管炎（PSC）和阻塞性胆汁淤积患者治疗的主要手段。肝硬化患者手术并发症风险增加，且更容易感染。由于 PSC 常进展为肝硬化，我们旨在评估 ERC 是否会增加肝硬化 PSC 患者的并发症风险。
在 383 例 PSC 患者中，208 例患者于 2009-2017 年接受内镜治疗。70 例患者在进行 ERC 时存在肝硬化，138 例患者无肝硬化迹象。总共分析了 663 例 ERC 手术，其中 250 例 ERC 患者存在肝硬化，413 例 ERC 患者无肝硬化。使用重复测量逻辑回归，从前瞻性获取的数据库中回顾性分析数据。
在 663 例 ERC 干预中，共记录了 40 例与操作相关的并发症（6%）。肝硬化患者和无肝硬化患者的并发症发生率相似（4.4%比 7.0%）。首次 ERC 与并发症风险增加相关（17.5%比 4.9%）。多变量分析显示，括约肌切开术、支架置入术和女性，而不是肝硬化的存在，是总体并发症的危险因素。无肝硬化患者在首次两次干预后碱性磷酸酶（ALP）和胆红素水平显著下降。相比之下，在肝硬化患者中，ERC 后 ALP 和胆红素水平没有显著下降。
在 PSC 患者中，肝硬化不是 ERC 后并发症的危险因素。因此，在有明确临床指征的患者中，肝硬化不应排除内镜干预。
