Evaluating the risk of adverse events with interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound procedures in cirrhotic patients

作     者：Timothy Yoo Raisa Epistola Jordan Epistola Lawrence Ku Michael W Fleischman Sofiya Reicher Viktor E Eysselein Linda A Hou 

作者机构：Department of Internal MedicineHarbor-UCLA Medical CenterTorranceCA 90509United States Department of PsychologySocialDecisionand Organizational Sciences ProgramUniversity of MarylandCollege ParkMD 20742United States Department of Internal MedicineDivision of GastroenterologyHarbor-UCLA Medical CenterTorranceCA 90509United States 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2019年第11卷第11期

页      面：523-530页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Fine-needle aspiration Fine-needle biopsy Hepatic cirrhosis Model for End-stage Liver Disease Child-Pugh Class Adverse events 

摘      要：BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in ***,these same patients often require interventional gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS).While studies examining this scenario exist,the overall body of evidence for adverse event rates associated with ERCP/EUS procedures is more *** sought add to the literature by examining the incidence of adverse events after ERCP/EUS procedures in our safety-net hospital population with the hypothesis that severity of cirrhosis correlates with higher adverse event *** To examine whether increasing severity of cirrhosis is associated with greater incidence of adverse events after interventional ERCP/EUS *** We performed a retrospective study of patients diagnosed with hepatic cirrhosis who underwent ERCP and/or EUS-guided fine needle aspirations/fine needle biopsies from January 1,2016 to March 14,2019 at our safety net *** recorded Child-Pugh and Model for End-stage Liver Disease(MELD-Na)scores at time of procedure,interventions completed,and 30-day post-procedural adverse *** analyses were done to assess whether Child-Pugh class and MELD-Na score were associated with greater adverse event rates and whether advanced techniques(single-operator cholangioscopy,electrohydraulic lithotripsy/laser lithotripsy,or needle-knife techniques)were associated with higher complication *** 77 procedures performed on 36 patients were *** study population consisted primarily of middle-aged Hispanic males.30-d procedure-related adverse events included gastrointestinal bleeding(7.8%),infection(6.5%),and bile leak(2%).The effect of Child-Pugh class C vs class A and B significantly predicted adverse events(β=0.55,P0.01).MELD-Na scores also signifi