Geisinger Wyoming Valley Medical Center Wilkes-Barre, PA
Umar Hayat, MD1, Saba Afroz, MD1, Pranav Patel, MD2, Karan Yagnik, MD3, Muhammad Kamal, MD4, Kamran Qureshi, MD5, Azhar Hussain, MD6, Harshit S. Khara, MD7, Kishore Kumar, MD8, Ali Siddiqui, MD9, Bradley D. Confer, DO2, David L.. Diehl, MD2 1Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 2Geisinger Health System, Danville, PA; 3Monmouth Medical Center, Long Branch, NJ; 4Hackensack Meridian Health, Edison, NJ; 5Saint Louis University School of Medicine, Saint Louis, MO; 6SUNY Upstate Medical University Hospital, Syracuse, NY; 7Geisinger Health System, Danville, NJ; 8Geisinger Community Medical Center, Scranton, PA; 9Maimonides Medical Center, Fairfax, VA Introduction: Thrombocytopenia is a significant complication of liver cirrhosis. Patients with cirrhosis face increased risks during procedures. This study examines the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in patients with cirrhosis and low platelet counts who are treated for choledocholithiasis. We aim to assess the impact of mild (101,000–150,000 cells/µL) versus moderate (51,000–100,000 cells/µL) thrombocytopenia on post-ERCP outcomes in a matched cohort of cirrhosis patients. Methods: A retrospective cohort study from the TriNetX network included patients aged 18 and older with cirrhosis undergoing ERCP for choledocholithiasis. Cohorts were divided by platelet counts into mild and moderate thrombocytopenia, with 4,255 patients each. Propensity score matching considered 15 factors, including demographics (age, gender, race) and lab parameters (PT, aPTT, INR, hemoglobin, hematocrit) and BMI. Univariate regression analysis assessed all-cause mortality as the primary outcome, while secondary outcomes included sepsis, severe sepsis, septic shock, AKI, post-ERCP bleeding, blood transfusion needs, ICU admission, and adverse events. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: After propensity matching, 4255 patients were analyzed for primary and secondary outcomes. All-cause mortality was significantly higher in the post-ERCP cohort with moderate thrombocytopenia [OR (95% CI): 1.48 (1.26 - 1.75)]. Moderate thrombocytopenia also correlated with increased adverse events, including sepsis (OR 1.31; 95% CI 1.15–1.48), acute kidney injury (OR 1.36; 95% CI 1.21–1.52), and hepatorenal syndrome (OR 1.74; 95% CI 1.22–2.47). Significant post-procedural outcomes included post-ERCP bleeding (OR 1.25; 95% CI 1.11–1.72) and the need for blood transfusion (OR 1.70; 95% CI 1.42–2.03) within the moderate thrombocytopenia cohort. Other outcomes like ICU admission, jaundice, bile duct perforation, post-ERCP pancreatitis, and abdominal pain showed no significant differences. Figures 1 &2. Discussion: Patients with cirrhosis and moderate thrombocytopenia undergoing ERCP for choledocholithiasis experience significantly worse outcomes than those with mild thrombocytopenia, including higher mortality rates, increased blood transfusion requirements, and greater complications such as sepsis and AKI. These findings highlight the necessity of thorough pre-procedural planning and vigilant monitoring in this high-risk population.
Figure: Table 1. Essential characteristics of the patients were included in the groups before and after propensity matching.
Figure: Table 2. Primary and Secondary Outcomes in cirrhotic patients with thrombocytopenia post-ERCP for choledocholithiasis
Disclosures: Umar Hayat indicated no relevant financial relationships. Saba Afroz indicated no relevant financial relationships. Pranav Patel indicated no relevant financial relationships. Karan Yagnik indicated no relevant financial relationships. Muhammad Kamal indicated no relevant financial relationships. Kamran Qureshi indicated no relevant financial relationships. Azhar Hussain indicated no relevant financial relationships. Harshit Khara indicated no relevant financial relationships. Kishore Kumar indicated no relevant financial relationships. Ali Siddiqui indicated no relevant financial relationships. Bradley Confer indicated no relevant financial relationships. David Diehl indicated no relevant financial relationships.
Umar Hayat, MD1, Saba Afroz, MD1, Pranav Patel, MD2, Karan Yagnik, MD3, Muhammad Kamal, MD4, Kamran Qureshi, MD5, Azhar Hussain, MD6, Harshit S. Khara, MD7, Kishore Kumar, MD8, Ali Siddiqui, MD9, Bradley D. Confer, DO2, David L.. Diehl, MD2. P5783 - Post-ERCP Outcomes in Cirrhotic Patients With Thrombocytopenia: A Propensity-Matched Retrospective Comparative Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
