To evaluate the frequency, type, and predictors of hepatic decompensation following endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis, and to assess the impact of baseline clinical and biochemical parameters on post-procedural outcomes.

We retrospectively analyzed 67 cirrhotic patients who underwent ERCP between January 2021 and December 2023 at a tertiary referral center. Child–Pugh and MELD-Na scores were recorded pre- and post-procedure. Variables analyzed included demographics, etiology of cirrhosis, indication and type of ERCP intervention, and post-procedural complications such as ascites, hepatic encephalopathy (HE), variceal bleeding, jaundice, and hepatorenal syndrome (HRS). Statistical analysis included Wilcoxon, Chi-square, ANOVA, and univariate logistic regression tests.

The study cohort included 49 men (73%) and 18 women (27%), mean age 65 ± 10.9 years. The predominant etiology was alcoholic cirrhosis (61%). ERCP indications were choledocholithiasis (60%), malignant biliary stricture (28%), benign biliary stricture (8%), and pancreatic disease (4%). Post-procedural deterioration in hepatic function was significant (Child–Pugh p = 0.008; MELD-Na p = 0.006). Hepatic decompensation occurred in 25% of patients, most commonly ascites and HE. Logistic regression identified post-ERCP Child–Pugh (OR 2.35; p < 0.001) and MELD-Na (OR 1.19; p = 0.001) as independent predictors of complications.

ERCP in cirrhotic patients carries a substantial risk of post-procedural hepatic decompensation, particularly in advanced disease stages. Careful patient selection, pre-procedural optimization, and close post-procedural monitoring are essential to mitigate risk and improve outcomes.