Abstract
The endoscopic retrograde cholangio-pancreatography (ERCP) is considered a main therapeutic intervention in the management of biliary and pancreatic disorders. In the average risk populations it is associated with adverse events. The most common adverse event is post-ERCP pancreatitis. Patients with liver cirrhosis are increasingly seen in ERCP theaters with different indications for the ERCP. Because cirrhotic patients are prone to complications it is expected that they develop more adverse events when operated with ERCP. Bleeding diathesis is the most serious because of the underlying coagulopathy and thrombocytopenia that are commonly encountered among them in particular with advanced Child class. In this mini review we discussed how different is the ERCP among cirrhotics regarding the expected benefits and the reported risks and we showed our experience in dealing with this subgroup of patients. The art of managing cirrhotic patients with ERCP is a team work and not a one man show.
Highlights
The development of endoscopic retrograde cholangiopancreatography (ERCP) in late sixties and early seventies of the last century was a major breakthrough in the management of biliary and pancreatic disorders
Among patients with liver cirrhosis we proved that invasive techniques [12,18] including needle knife fistulotomy and large balloon dilatation can be performed at no extra cost of adverse events when carefully pre-operatively prepared and selected
Cirrhotic patients are highly susceptible to infections [32] and it accounts for major morbidity and mortality among them and occurrence of cholangitis is expected to add a burden to the ill situation of those patients
Summary
The development of endoscopic retrograde cholangiopancreatography (ERCP) in late sixties and early seventies of the last century was a major breakthrough in the management of biliary and pancreatic disorders. Child score was developed to assess the functional capacity of the diseased liver and is used to predict the morbidity and mortality among cirrhotic patients and is widely used due to the ease of its calculation and its reproducibility but of large CBD stones including large papillary dilatation, different modalities of lithotripsy and more recently laser fragmentation with the use of spyglass with acceptable success rates [12,13]. In earlier studies [12,18,20] we proved safety and efficacy of some invasive and advanced ERCP interventions in cirrhotics with acceptable adverse events rates (Table 2).
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