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

Abstract

INTRODUCTION: Biliary complications following liver transplantation are usually managed with endoscopic retrograde cholangiopancreatography (ERCP); however, the literature on post-ERCP complications remains poorly reported and largely inconsistent in this patient population. Hereby we aimed to systematically review and analyze the literature on complication rates associated with the performance of ERCP in patients with liver transplant. METHODS: We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through May 2019 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 prevalence were calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques. RESULTS: Fourteen studies with a total of 1787 patients were included in this analysis. In total, 3192 ERCPs were performed on these patients. The pooled all-complication rate was 5.2% (95% CI: 0.035–0.075) (Figure 1). 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) (Figure 2a–d). 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%) (Figure 3). CONCLUSION: The risk of post-ERCP complications has been a major concern for many endoscopists in patients with liver transplantation. This might be related to theoretical concerns of distorted anatomy and difficult cannulation, combined with a general lack of evidence on the true prevalence of these complications. Our study confirms that post-ERCP complication rates are comparable to the general population undergoing ERCP and hence, peri-procedural evaluation and management should be continued as per the standard of care in this patient population.