The Safety of Endoscopy in Cirrhosis

Abstract

Abstract Background: Endoscopic procedures are amongst the most commonly performed medical procedures and the serious adverse event rate is reported to be 1-3 adverse events per 1000 procedures. Aims: Here, we have examined the safety of endoscopy specifically in cirrhotic populations. Methods: We conducted a retrospective case (cirrhosis) -control (non-cirrhosis) study of the outcomes of patients undergoing endoscopy in a large academic medical center. The primary outcome was a procedural or post-procedural complication. Complete clinical data were collected for all patients undergoing endoscopic procedures - including esophagogastroduodenoscopy, colonoscopy, EUS, ERCP, flexible sigmoidoscopy, and others. Cirrhosis was carefully defined based on clinico-pathological grounds. Results: We identified 16,779 patients who underwent endoscopy, including 2,618 with cirrhosis and 14,161 without cirrhosis. There were 167 complications (0.99%), which included 15/2618 cirrhotics (0.6%) and 152/14,161 (1.1%) non-cirrhotics. The most common complications were cardiopulmonary (including hypotension, hypoxemia, and ) found in 67% of patients; procedurally related complications occurred in 19% of patients. The complication rate was the same or lower in cirrhotics than controls undergoing esophagogastroduodenoscopy (0.6% vs 0.9%, p = 0.03), colonoscopy (0.6% vs. 0.6%, p = NS), or ERCP (0.7% vs. 1.4%, p = NS)Logistic regression analysis identified the following features to be associated with an increased risk of having a complication: inpatient status, history of myocardial infarction, and an EUS procedure. Conclusions: Endoscopy in cirrhotic patients was as safe or safer in cirrhotic patients compared to others undergoing the same procedures.