S2207 Cirrhosis Increases the Odds of ERCP Adverse Events but Not Post-ERCP Pancreatitis: A Propensity-Matched Analysis

Introduction: Patients with cirrhosis are at an increased risk choledocholithiasis, requiring intervention with endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP-related adverse events in this population is limited, hence this study. Methods: This retrospective cohort study utilized the TriNetX database to assess the odds of ERCP-related adverse events in patients with cirrhosis. Primary outcomes were ERCP-related pancreatitis (PEP), bleeding, cholangitis, and perforation. Secondary outcomes were failure to extubate/new post-procedure intubation, intensive care unit (ICU) admissions, and all-cause mortality. These outcomes were further stratified by cirrhosis severity (compensated and decompensated). Results: After propensity score matching, each cohort included 16,038 patients. Patients with cirrhosis had a higher odd of bleeding (OR 1.7, P < 0.001), cholangitis (OR 1.5, P < 0.001), ICU admissions (OR 1.4, P < 0.001) and mortality (OR 1.8, P < 0.001) following ERCP compared to the matched cohort control. The odds of PEP (OR 0.9, P = 0.355), perforation (OR 0.9, P = 0.810) and post-procedure intubation (OR 1.2, P = 0.267) were statistically similar between the 2 cohorts. The odds of all ERCP-related events was higher in the decompensated group, except PEP and perforation. Conclusion: Cirrhosis is associated with increased rates of ERCP- related adverse events with the exceptions of post-ERCP pancreatitis and perforation. Stronger associations were seen in the decompensated cirrhosis group leading us to believe that optimizing these patients is crucial prior to performing ERCP. Further prospective research is needed to validate our findings.