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. 2021 Oct;14(5):259-267.
doi: 10.14740/gr1391. Epub 2021 Sep 15.

The Incidence of Endoscopic Retrograde Cholangiopancreatography-Related Complications in Patients With Liver Transplant: A Meta-Analysis and Systematic Review

Mohammad Alomari  1 , Laith Al Momani  2 , Ahmed Alomari  3 , Shrouq Khazaaleh  4 , Asif Ali Hitawala  4 , Amani Khasawneh  5 , Prashanthi N Thota  6 , Sreeni S Jonnalagadda  2 , Madhusudhan R Sanaka  6
Affiliations

The Incidence of Endoscopic Retrograde Cholangiopancreatography-Related Complications in Patients With Liver Transplant: A Meta-Analysis and Systematic Review

Mohammad Alomari et al. Gastroenterology Res. 2021 Oct.

Abstract

Background: 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.

Methods: 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.

Results: 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, I2 = 72.88%).

Conclusion: 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.

Keywords: Complications; Endoscopic retrograde cholangiopancreatography; Liver transplant; Pancreatitis and cholangitis.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
Flow diagram illustrating the selection process.
Figure 2
Figure 2
Forrest plot, post-ERCP all-complication rate in liver transplant patients. ERCP: endoscopic retrograde cholangiopancreatography; CI: confidence interval.
Figure 3
Figure 3
Forrest plots, pooled event rate for post-ERCP pancreatitis (a), bleeding (b), infection (c) and cholangitis (d). ERCP: endoscopic retrograde cholangiopancreatography; CI: confidence interval.
Figure 4
Figure 4
(a) Forrest plot, pooled OR of post-ERCP pancreatitis versus non-transplant patients. (b) Funnel plot of standard error by log OR. OR: odds ratio; ERCP: endoscopic retrograde cholangiopancreatography; CI: confidence interval.
See this image and copyright information in PMC

References

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