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| 1 | Endoscopic retrograde cholangiopancreatography in cirrhosis-a systematic review and meta-analysis focused on adverse events显示文摘AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography(ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events.METHODS We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017.RESULTS A total of 6,505 patients from 15 studies were analyzed(male ratio 59%, mean age 59 years), 11% with alcoholic and 89% with non-alcoholic cirrhosis, with 56.2% Child-Pugh class A, and 43.8% class B or C. Indications for ERCP included choledocholithiasis 60.9%, biliary strictures 26.2%, gallstone pancreatitis 21.1% and cholangitis 15.5%. Types of interventions included endoscopic sphincterotomy 52.7%, biliary stenting 16.7% and biliary dilation 4.6%. Individual adverse events included hemorrhage in 4.58%(95%CI: 2.77-6.75%, I^2 = 85.9%), post-ERCP pancreatitis(PEP) in 3.68%(95%CI: 1.83-6.00%, I^2 = 89.5%), cholangitis in 1.93%(95%CI: 0.63-3.71%, I^2 = 87.1%) and perforation in 0.00%(95%CI: 0.00-0.23%, I^2 = 37.8%). Six studies were used for comparison of ERCPrelated complications in cirrhosis vs non-cirrhosis, which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63(95%CI: 1.27-2.09, I2 = 65%): higher rates of hemorrhage with OR of 2.05(95%CI: 1.62-2.58, I^2 = 2.1%) and PEP with OR of 1.33(95%CI: 1.04-1.70, I2=65%), but similar cholangitis rates with OR of 1.23(95%CI: 0.67-2.26, I^2 = 44.3%).CONCLUSION There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP. A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis. | Shailender Singh Mashiana Amaninder Singh Dhaliwal Harlan Sayles Banreet Dhindsa Ji Won Yoo Qing Wu shailender singh Ali A Siddiqui Gordon Ohning Mohit Girotra Douglas G Adler | 2018 | World Journal of Gastrointestinal Endoscopy2018，10，11： | 6 |
| 2 | Leaf senescence: correlated with increased levels of membrane permeability and lipid peroxidation, and decreased levels of superoxide dismutase and catalase显示文摘 | Dhindsa R S Plumb-Dhindsa P Thorpe T A | 1981 | J Exp Botany1981，32，： | 1 |
| 3 | Leaf senescence correlated with increased levels of membrane permeability and lipid peroxidation and decreased levels of superoxide dismutase and catalase显示文摘 | Dhindsa R S Dhindsa P P Thorpe T A | 1981 | Journal of Experimental Botany1981，32，： | 1 |
| 4 | Leaf senescence: correlated with increased levels of membrane permeability and lipid pea'oxidation, and decreased levels of superoxide dismutase and catalase 显示文摘 | DHINDSA R S DHINDSA P P THROPE T A | 1981 | Exp Bot1981，，3： | 1 |
| 5 | Leaf senesence: cor- related with increased levels of membrane permeability and lipid peroxidation and decreased levels of superoxide dismu- tase and catalase 显示文摘 | Dhindsa R S Dhindsa P P Thorpe T A | 1981 | Journal of Experimental Botany1981，32，1： | 1 |
| 6 | Leaf senescence: correlated with increased leaves of membrane permeability and lip id peroxidation, and decreased levels of superoxide dismutase and catalase显示文摘 | Dhindsa R S Dhindsa P P Thorpe T A | 1981 | Journal of Experimental Botany1981，32，： | 1 |
| 7 | Lzaf Senescence correlated with increared levels of membrane pvrmeability and lipid peroxidation and decreased levels of superoxide desmutase and cata- lase显示文摘 | Dhindsa R S Plumb-Dhindsa P L Thorpe T A | 1981 | Exp Bot1981，，4： | 1 |
| 8 | Leaf senescence:Correlated with increased levels of membrane per- meability and lipid peroxidation,and decreased levels of super- oide dismutase and catalase显示文摘 | DHINDSA R S PLUMB-DHINDSA P THORPE T A | 1981 | Journal of Experimental Botany1981，，： | 1 |
| 9 | Leaf senescence:Correlated with increased levels of membrane permeability a lipid peroxidation,and decreased levels of superoxide dismutas and catalase显示文摘 | Dhindsa R S Plump-Dhindsa P Thorpe T A | 1981 | Journal of Experimental Botany1981，32，1： | 1 |
| 10 | Evaluation of variable speed limits for real-time freeway safety improvement显示文摘 | ABDEL-ATY M DILMORE J DHINDSA A | 2006 | Accident Analysis and Prevention2006，38，2： | 1 |
| 11 | Durability of effects of exenatide treatment on glycemic control, body weight, systolic blood pressure, C-reactive protein, and triglyceride concentrations显示文摘 | Varanasi A Chaudhuri A Dhindsa S | 2011 | Endocr Pract2011，17，2： | 1 |
| 12 | Leaf Senescence correlated with increased levels of membrane permeability and lipid peroxidation and decreased levels of superoxide des mutase and catalase显示文摘 | Dhindsa R S Plumb-Dhindsa P L Thorpe T A | 1981 | Exp Bot1981，，： | 1 |
| 13 | Effect of abscisic acid on in vitro growth of cotton fibre显示文摘 | DHINDSA R S Beasley C A Ting I P | 1976 | Planta1976，130，： | 1 |
| 14 | Leaf senescence correlated with increase levels of membrane permeability and lipid peroxidation and decrease levels dismutase and catalase显示文摘 | Dhindsa R S Plumb-Dhindsa P Thorpe T A | 1982 | Journal of Experimental Botany1982，32，： | 1 |
| 15 | Low temperature signal transduction durning cold acclimation:protein phosphatase 2A as an early target for cold-inactivation显示文摘 | Monroy A F Sangwan V Dhindsa R S | | 0，，： | 1 |
| 16 | Minimally invasive clinicalapproach in indirect pulp therapy and healing of deep carious le-sions 显示文摘 | Opal S Garg S Dhindsa A | 2014 | J Clin Pediatr Dent2014，38，3： | 1 |
| 17 | Leaf senescence: correlated with increased levels of membrane permeability and lipid peroxidation, and decreased levels of superoxide dismutase and catalase 显示文摘 | Dhindsa R S Plumb - Dhindsa P Thorpe T A | 1981 | Journal of Experimental Botany1981，32，： | 1 |
| 18 | Leaf senescence:Correlated with increased levels of membrane permeability and lipid peroxidation and decreased levels of superoxidation dismutase and catalase显示文摘 | Dhinsa R S Dhindsa P P Thorpe T A | 1981 | J Exp Bot1981，32，： | 1 |
| 19 | Evaluation of variable speed limits for real-time freeway safety improvement显示文摘 | ABDEL A M DILMORE J DHINDSA A | 2006 | Accident Analysis & Prevent ion2006，38，2： | 1 |
| 20 | Leaf senescence:Correlated with increased levels of membrane permeability andlipid peroxidation, and decreased levels of superoxide dismutase and catalase显示文摘 | DHINDSA R S PLUMB-DHINDSA P THOROPE T A | 1981 | J ournal of Experimental Botany1981，32，： | 1 |
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