Safety and effectiveness of ERCP for patients with decompensated cirrhosis combined with choledocholithiasis / 中华消化内镜杂志

ABSTRACT

Objective To evaluate safety and effectiveness of endoscopic retrograde cholangiopancreatography ( ERCP ) for patients with decompensated cirrhosis combined with choledocholithiasis. Methods A retrospective analysis was performed on data of 79 patients with decompensated cirrhosis combined with choledocholithiasis, 92 patients with chronic viral hepatitis, and 114 patients without liver disease who underwent ERCP at the First Hospital of Lanzhou University from December 2012 to December 2016. Intraoperative operating conditions, postoperative improvement of liver function indices, and complications among the three groups were compared and analyzed. Results The level of serum prothrombin time before ERCP in patients with cirrhosis (12. 9±2. 2) s was higher than that in patients with chronic viral hepatitis (12. 1±1. 9) s and those without liver disease (11. 7±1. 4) s, the difference was statistically significant ( F=21. 530, P<0. 001) . Operating time in patients with cirrhosis was longer than that of two other groups ( 58. 58 ± 19. 40 min VS 52. 53 ± 16. 74 min VS 49. 81 ± 14. 82 min, F=6. 444, P = 0. 002 ) . In patients with cirrhosis, postoperative liver function indices of aspartate aminotransferase ( 66. 0 IU/L VS 53. 0 IU/L) , alanine aminotransferase ( 61. 0 IU/L VS 52. 0 IU/L) ,γ-glutamyltransferase ( 318. 0 IU/L VS 231. 0 IU/L ) , alkaline phosphatase ( 232. 0 μmol/L VS 210. 0 μmol/L) , and total bilirubin ( 65. 7 μmol/L VS 56. 3 μmol/L ) were all lower compared with preoperative ones ( all P<0. 05) . No perforation or death occurred in the three groups. There were 3 cases ( 3. 8％) of mild bleeding at duodenal papilla after endoscopic sphincteropapillotomy in cirrhosis patients, i.e., 2 cases of Child-Pugh C and 1 case of Child-Pugh B. Errhysis occurred in one case ( 1. 27％) of Child-Pugh C patient at lower esophagus varices. There were no statistical differences on incidences of complications among the three groups ( P>0. 05) . Conclusion ERCP is safe and effective for Child-Pugh A and B patients with decompensated cirrhosis combined with choledocholithiasis. Liver function and blood coagulation function should be improved in Child-Pugh C patients before ERCP.