Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 10, Number 3, June 2017, pages 177-181

International Normalized Ratio Does Not Predict Gastrointestinal Bleeding After Endoscopic Retrograde Cholangiopancreatography in Patients With Cirrhosis

**Table 1.** Univariate Analysis Comparing ERCP Procedures in Cirrhotic Patients vs. Non-Cirrhotic Patients
	Non-cirrhotics (procedures) (n = 392)	Cirrhotics (procedures) (n = 129)	P value
Biological MELD, median (range)	n/a	14 (6 - 33)
CTP
A	n/a	34 (26%)
B	n/a	72 (56%)
C	n/a	23 (18%)
Etiology of liver disease
PSC	n/a	84 (65%)
NASH	n/a	5 (4%)
HCV	n/a	7 (5%)
ETOH	n/a	11 (9%)
Other	n/a	29 (23%)
ERCP indication
PSC	11 (3%)	56 (43%)	< 0.001
Gallstone pancreatitis and cholangitis	114(29%)	22 (17%)	0.007
Jaundice or cholestasis	45 (12%)	22 (17%)	0.10
Stricture	62 (16%)	12 (9%)	0.07
Abnormal imaging	66 (17%)	8 (6%)	0.003
Other	93 (24%)	9 (7%)	< 0.001
Anticoagulation	39 (10%)	6 (5%)	0.063
Antiplatelet agents	95 (24%)	16 (12%)	0.004
INR, mean (SD)	1.2 (0.4)	1.3 (0.4)	< 0.001
PT, mean (SD)	14.6 (3.1)	15.9 (3.8)	< 0.001
Platelets, mean (SD)	227 (103)	177 (105)	< 0.001
Pre-procedure FFPs	10 (3%)	7 (5%)	0.107
Sphincterotomy	213 (55%)	35 (27%)	< 0.001

Table 1. Univariate Analysis Comparing ERCP Procedures in Cirrhotic Patients vs. Non-Cirrhotic Patients

Non-cirrhotics (procedures) (n = 392)

Cirrhotics (procedures) (n = 129)

P value

Biological MELD, median (range)

n/a

14 (6 - 33)

CTP

n/a

34 (26%)

n/a

72 (56%)

n/a

23 (18%)

Etiology of liver disease

PSC

n/a

84 (65%)

NASH

n/a

5 (4%)

HCV

n/a

7 (5%)

ETOH

n/a

11 (9%)

Other

n/a

29 (23%)

ERCP indication

PSC

11 (3%)

56 (43%)

< 0.001

Gallstone pancreatitis and cholangitis

114(29%)

22 (17%)

0.007

Jaundice or cholestasis

45 (12%)

22 (17%)

0.10

Stricture

62 (16%)

12 (9%)

0.07

Abnormal imaging

66 (17%)

8 (6%)

0.003

Other

93 (24%)

9 (7%)

< 0.001

Anticoagulation

39 (10%)

6 (5%)

0.063

Antiplatelet agents

95 (24%)

16 (12%)

0.004

INR, mean (SD)

1.2 (0.4)

1.3 (0.4)

< 0.001

PT, mean (SD)

14.6 (3.1)

15.9 (3.8)

< 0.001

Platelets, mean (SD)

227 (103)

177 (105)

< 0.001

Pre-procedure FFPs

10 (3%)

7 (5%)

0.107

Sphincterotomy

213 (55%)

35 (27%)

< 0.001

**Table 2.** Post-Procedure Complications
	Non cirrhotics (n = 392)	Cirrhotics (n = 129)	P value
Any complication	52 (13%)	25 (19%)	0.007
Child-Turcotte-Pugh A	n/a	4 (16%)
Child-Turcotte-Pugh B	n/a	16 (64%)
Child-Turcotte-Pugh C	n/a	5 (20%)
GI bleeding	12 (3%)	8 (6%)	0.117
GI bleeding requiring blood transfusion	3 (0.1%)	5 (4%)	0.025
Post-ERCP pancreatitis	17 (4%)	7 (5%)	0.630
Cholangitis	7 (2%)	8 (6%)	0.015
Death	17 (4%)	4 (3%)	0.618

Table 2. Post-Procedure Complications

Non cirrhotics (n = 392)

Cirrhotics (n = 129)

P value

Any complication

52 (13%)

25 (19%)

0.007

Child-Turcotte-Pugh A

n/a

4 (16%)

Child-Turcotte-Pugh B

n/a

16 (64%)

Child-Turcotte-Pugh C

n/a

5 (20%)

GI bleeding

12 (3%)

8 (6%)

0.117

GI bleeding requiring blood transfusion

3 (0.1%)

5 (4%)

0.025

Post-ERCP pancreatitis

17 (4%)

7 (5%)

0.630

Cholangitis

7 (2%)

8 (6%)

0.015

Death

17 (4%)

4 (3%)

0.618

**Table 3.** Characteristics by GI Bleeding in All Patients
	No GIB (n = 501)	GIB (n = 20)	P value
Anticoagulation	40 (8%)	5 (25%)	0.008
Antiplatelet	107 (21%)	4 (20%)	0.884
Pre-procedure FFPs	13 (3%)	4 (20%)	0.003
Sphincterotomy	234 (47%)	14 (70%)	0.065
INR, mean (SD)	1.2 (0.3)	1.5 (0.8)	< 0.001
PT, mean (SD)	15 (3)	18 (7)	0.001
Platelet, mean (SD)	215 (106)	206 (85)	0.828

Table 3. Characteristics by GI Bleeding in All Patients

No GIB (n = 501)

GIB (n = 20)

P value

Anticoagulation

40 (8%)

5 (25%)

0.008

Antiplatelet

107 (21%)

4 (20%)

0.884

Pre-procedure FFPs

13 (3%)

4 (20%)

0.003

Sphincterotomy

234 (47%)

14 (70%)

0.065

INR, mean (SD)

1.2 (0.3)

1.5 (0.8)

< 0.001

PT, mean (SD)

15 (3)

18 (7)

0.001

Platelet, mean (SD)

215 (106)

206 (85)

0.828

**Table 4.** Characteristics by GI Bleeding in Cirrhotic Patients
	No GIB (n = 121)	GIB (n = 8)	P value
Anticoagulation	5 (4%)	1 (13%)	0.324
Antiplatelet	16(13%)	0 (0%)	0.272
Pre-procedure FFPs	5 (4%)	2 (25%)	0.060
Sphincterotomy	30 (25%)	5 (63%)	0.034
INR, mean (SD)	1.2 (0.3)	1.7 (1.2)	0.257
PT, mean (SD)	15.7 (3.1)	19.3 (9.4)	0.401
Platelet, mean (SD)	176.9 (104.3)	180.8(118.1)	0.864

Table 4. Characteristics by GI Bleeding in Cirrhotic Patients

No GIB (n = 121)

GIB (n = 8)

P value

Anticoagulation

5 (4%)

1 (13%)

0.324

Antiplatelet

16(13%)

0 (0%)

0.272

Pre-procedure FFPs

5 (4%)

2 (25%)

0.060

Sphincterotomy

30 (25%)

5 (63%)

0.034

INR, mean (SD)

1.2 (0.3)

1.7 (1.2)

0.257

PT, mean (SD)

15.7 (3.1)

19.3 (9.4)

0.401

Platelet, mean (SD)

176.9 (104.3)

180.8(118.1)

0.864