Comparative evaluation of post ERCP complications in patients with portal hypertension and without portal hypertension

In patients with portal hypertension (PHT) after ERCP, theoretically, the risk of infection (cholangitis, acid infection etc.) may increase due to leukopenia and leukocyte dysfunction, bleeding (endoscopic sphincterotomy (ES) bleeding, bleeding after dilatation) due to thrombocytopenia and thrombocyte dysfunction, post-ERCP pancreatitis (PEP) due to low effective blood volume, and bleeding due to existing gastroesophageal varices. The aim of this study is to determine whether the frequency of post ERCP complications increases in patients with PHT. 31 patients with PHT who underwent ERCP between January 2018 and June 2021 [12 F, 45.5±14.7 years, 10 PSC, 8 portal cholangiopathy, 13 parenchymal cirrhosis of various etiologies, mean MELD: 12 (6-20), 13 Child A, 17 Child B and 1 Child C] data were compared retrospectively/prospectively with 77 ERCP procedures performed in 71 hospitalized patients without PHT (39 F, 56.9±16.4 years age) who underwent ERCP. In the case group, leukocytes (median 4900 /μL x 7600 /μL), platelets (median 116000 /μL x 227000 /μL) values were lower, while INR (median 1.2 x 1.09) was higher. In both groups, the procedure was mostly performed with midazolam + meperidine anesthesia. Before the procedure, platelet support was given to 3 patients and FFP support to 2 patients in the case group. In the control group, the drugs of 11 patients using anticoagulant/antiaggregant were discontinued in an appropriate time. Patients with 'naive' papillae received 100 mg of rectal indomethacin before the procedure and Ringer Lactate infusion during and after the procedure. If the pancreatic duct was cannulated, pancreatic stent was inserted (1 and 5 patients). Cannulation success (30/31 x 71/71) was similar. ES was more common in the control group (22.6% x 60.6%, p=0.001; other patients already had ES). The rates of papilla dilatation (19.3 % x 14 %, p=0.55 ), biliary dilatation (22.6% x 9.9%, p=0.11), stone removal (38.7% x 53.5%, p=0.246), stent insertion (64.5% x 42.3 %, p=0.064) were not different. There was no difference in total complications (9.7% x 12.7% ) and ES bleeding (0% x 1.1%), PEP (3.2% x 4.2%) and cholangitis (6.5% x 7%), (total complication: p=1.000, type of complication: p=0.264). There was no difference between the groups in terms of the number of procedures and the presence of complications (31 patients/71 procedures, 11.3 % complication rate, 71 patients/77 procedures, 13 % complication rate, p=0.946). None of the patients had varicose bleeding and procedure-related death. The results of our study show that although the number of patients with advanced parenchymal cirrhosis is small, portal hypertension does not significantly increase the incidence of post ERCP complications when necessary precautions are taken.