Alomari Mohammad, Al Momani Laith, Alomari Ahmed, Khazaaleh Shrouq, Hitawala Asif Ali, Khasawneh Amani, Thota Prashanthi N, Jonnalagadda Sreeni S, Sanaka Madhusudhan R
Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA.
Department of Gastroenterology and Hepatology, University of Missouri - Kansas City, Kansas City, MO, USA.
Gastroenterology Res. 2021 Oct;14(5):259-267. doi: 10.14740/gr1391. Epub 2021 Sep 15.
Existing literature on post-endoscopic retrograde cholangiopancreatography (ERCP) complications in patients with liver transplant remains scarce and largely inconsistent. We therefore aimed to systematically review and analyze the literature on complication rates associated with ERCP in patients with liver transplant.
We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through March 2020 to identify all the studies that evaluated post-ERCP complications in patients with liver transplant. Effect estimates from the individual studies were extracted and combined using the random effect, generic inverse variance method of DerSimonian and Laird, and a pooled odds ratio (OR) and event rates were calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques.
Fourteen studies with a total of 1,787 patients were analyzed. In total, 3,192 ERCPs were performed on these patients. The pooled all-complication rate was 5.2% (95% confidence interval (CI): 0.035 - 0.075). Procedural complications analyzed included post-ERCP pancreatitis 3.4% (95% CI: 0.025 - 0.047), bleeding 1.1% (95% CI: 0.006 - 0.020), infections 0.2% (95% CI: 0.025 - 0.047), and cholangitis 0.8% (95% CI: 0.004 - 0.020). No cases of periprocedural death were reported. The pooled OR for post-ERCP pancreatitis in patients with liver transplant compared to patients without liver transplant was 1.289 (95% CI: 0.455 - 3.653, P = 0.633, I = 72.88%).
Post-ERCP complication rates in liver transplant patients are comparable to the general population and hence, peri-procedural evaluation and management may follow the current standards of care in this patient population.
关于肝移植患者内镜逆行胰胆管造影术（ERCP）后并发症的现有文献仍然稀少，且在很大程度上不一致。因此，我们旨在系统回顾和分析有关肝移植患者ERCP相关并发症发生率的文献。
我们在PubMed、PubMed Central、Embase和ScienceDirect数据库中进行了全面的文献检索，检索时间从数据库创建至2020年3月，以识别所有评估肝移植患者ERCP后并发症的研究。提取各个研究的效应估计值，并使用DerSimonian和Laird的随机效应、通用逆方差方法进行合并，计算合并比值比（OR）和事件发生率。生成森林图，并使用传统技术评估发表偏倚。
分析了14项研究，共纳入1787例患者。这些患者总共接受了3192次ERCP。合并的所有并发症发生率为5.2%（95%置信区间（CI）：0.035 - 0.075）。分析的操作并发症包括ERCP后胰腺炎3.4%（95% CI：0.025 - 0.047）、出血1.1%（95% CI：0.006 - 0.020）、感染0.2%（95% CI：0.025 - 0.047）和胆管炎0.8%（95% CI：0.004 - 0.020）。未报告围手术期死亡病例。肝移植患者与非肝移植患者相比，ERCP后胰腺炎的合并OR为1.289（95% CI：0.455 - 3.653，P = 0.633，I² = 72.88%）。
肝移植患者ERCP后的并发症发生率与普通人群相当，因此，围手术期评估和管理可遵循该患者群体当前的护理标准。
