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. 2018 Aug 20;13(8):e0202686.
doi: 10.1371/journal.pone.0202686. eCollection 2018.

Risk of endoscopic biliary interventions in primary sclerosing cholangitis is similar between patients with and without cirrhosis

Moritz Peiseler  1 , David Reiners  1 , Hans O Pinnschmidt  2 , Marcial Sebode  1 , Franziska Jung  1 , Johannes Hartl  1 , Roman Zenouzi  1 , Hanno Ehlken  1   3 , Stefan Groth  3 , Guido Schachschal  3 , Thomas Rösch  3 , Christina Weiler-Normann  1   4 , Ansgar W Lohse  1 , Christoph Schramm  1   4
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Risk of endoscopic biliary interventions in primary sclerosing cholangitis is similar between patients with and without cirrhosis

Moritz Peiseler et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of all patients included in the analysis.
Out of a total of 383 patients with PSC managed at our centre, 208 patients received at least one ERC between 2009–2017. In 70 patients with 250 procedures, cirrhosis was detected. Another 138 patients with 413 ERC procedures had not progressed to cirrhosis.
Fig 2
Fig 2. Serum ALP and bilirubin levels before and after endoscopic intervention.
Mean alkaline phosphatase (ALP) and bilirubin serum levels of patients without cirrhosis (A, B) and with cirrhosis (C, D) before and up to three months after therapeutic ERC. ERC = endoscopic retrograde cholangiography. *** P < 0.0001; ** p < 0.001; n.s. = not significant.
See this image and copyright information in PMC

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