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Bret T. Petersen, MD, FASGE

Associate Editor
Pancreatobiliary

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Biography

Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.

Disclosures

Consultant 

Boston Scientific 

Advisory Board 

Ethicon/J & J

 

Summaries

Is Cirrhosis a Contraindication to ERCP?

Bret T. Petersen, MD, FASGE reviewing Leal C, et al. Am J Gastroenterol 2018 Sep 3.

Surgery and other interventions in patients with chronic liver failure are fraught with risk related to further compromising liver function. Whether this also applies to gastrointestinal endoscopy, and ERCP in particular, is unknown. This multicenter, retrospective, matched-cohort study, evaluated ERCPs performed in 158 patients with cirrhosis and 283 non-cirrhotic control patients. Other comparator groups included patients with cirrhosis with non-ERCP interventions and without interventions. Overall adverse events (AEs), including post-ERCP cholangitis and post-sphincterotomy bleeding, occurred more often in cases than among controls. Acute on Chronic Liver Failure (ACLF), defined as acute decline in liver function yielding severe clinical deterioration with jaundice, hepatic encephalopathy and/or renal failure within 4 weeks, occurred more commonly after ERCP (11.4%) or non-ERCP interventions (17.5%) compared to those without interventions of any variety (3.2%).


Comment:

Cirrhotic patients are at risk for ACLF following any procedural intervention, including ERCP and, in particular, when cholangitis or other post-procedure AEs arise. Those at greatest risk of post-ERCP ACLF had decompensated cirrhosis or MELD scores > 15. These data should guide us to be more discerning with regard to indications for ERCP among patents with cirrhosis and decompensation. When therapeutic intervention is not inevitable, less invasive approaches to diagnosis may be preferable. When ERCP is appropriately indicated we should use these data to obtain more transparent informed consent.


Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Citation(s):
Leal C, Prado V, Colan J, et al. Adverse events and acute chronic liver failure in patients with cirrhosis undergoing endoscopic retrograde cholangiopancreatography: a multicenter matched-cohort study. Am J Gastroenterol 2018 Sep 3. (Epub ahead of print) (https://doi.org/10.1038/s41395-018-0218-1)