Increased severity of post-endoscopic retrograde cholangiopancreatography complications in the elderly: an issue to be addressed

Increased severity of complications after therapeutic ERCP in geriatric patients with chronic pancreatitis: An observational study

Studies of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in geriatric patients have mainly examined patients with biliary diseases, rather than chronic pancreatitis (CP). This study aimed to evaluate the safety and success rate of therapeutic ERCP in geriatric patients with CP. The medical records of patients with CP aged over 65 years (group A) were retrospectively collected in a tertiary hospital from January 2013 to December 2018. Sex-matched CP patients under 65 years (group B) were randomly selected into the control group (matching ratio = 1:2). The success rate and the complication rate of therapeutic ERCP in 2 groups were compared. The risk factors for post-ERCP pancreatitis were investigated by univariate and multivariate analyses. A total of 268 ERCPs were performed in 179 patients of group A and 612 ERCPs in 358 patients of group B. The success rate of ERCP in group A was similar to that of group B (92.16% vs 92.32%; P = .936). The overall incidence of post-ERCP complications was 7.09% (19/268) and 5.72% (35/612) in group A and B, respectively (P = .436). However, geriatric patients had a significantly increased occurrence of moderate to severe complications (2.61% vs 0.16%; P = .002). Female gender (odds ratio [OR] = 3.40; P = .046), pancreas divisum (OR = 7.15; P = .049), dorsal pancreatogram (OR = 7.40; P = .010), and lithotripsy (OR = 0.15; P = .016) were significantly associated with risk of post-ERCP pancreatitis in geriatric patients. Therapeutic ERCP is safe and feasible in elderly patients with CP. However, occurrence of moderate to severe complications after ERCP increased in geriatric patients.

Safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography in elderly patients with a native papilla

BACKGROUND

The diagnosis and treatment of biliary and pancreatic diseases in elderly patients are a challenge for clinicians, while population ageing is becoming a prominent social issue. However, there are few clinical studies on therapeutic endoscopic retrograde cholangiopancreatography in elderly patients.

AIM

To evaluate the safety, efficacy, clinical characteristics, and influencing factors related to therapeutic ERCP in patients aged above 80 years.

METHODS

Data of 446 elderly patients (aged above 80 years) with a native papilla who underwent therapeutic ERCP form July 2011 to December 2020 were retrospectively analyzed. Their clinical characteristics, procedures of ERCP, and complications after ERCP were evaluated.

RESULTS

Mean age of included patients was (83.2 ± 3.3) years old. Significant comorbidities were found in 308 cases. One hundred and twenty-four cases had biliary, pancreatic, or papillary carcinomas. There was no significant difference in post-ERCP complications with regard to comorbidities or timing of ERCP. Overall complications were comparable between patients undergoing difficult and non-difficult cannulation. The incidence of complications in the malignant disease group was higher than that in the benign disease group (15.32% vs 7.86%, P < 0.05). The rate of biliary infection was higher in patients with malignant diseases than in those with benign diseases (6.45% vs 1.57%, P < 0.01). However, the rate of bleeding was higher in patients undergoing urgent ERCP than in those undergoing selective operation (8.33% vs 1.52%, P < 0.05).

CONCLUSION

The current study showed that therapeutic ERCP for patients aged 80 years or above is safe and effective. To avoid post-ERCP complications in elderly patients with high risk, detailed peri-ERCP evaluation may be necessary.

Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians' point of view

Background

The incidence of biliary tract pathology is growing with an age-related trend, and progresses as the population ages. Endoscopic Retrograde Cholangiopancreatography (ERCP) represents the gold standard for treatment in these cases, but evidence about its safety in the elderly is still debated.

Methods

We retrospectively analyzed the clinical records of all patients aged ≥65 undergoing ERCP between July 2013 and July 2015. Of 387 ERCP cases, 363 (~ 94%) were completed entirely. The mean age of the study population (n = 363) was 79.9 years old (range 70–95), with 190 subjects aged 70–79 and 173 older than 80. We recorded demographics, Charlson Comorbidity index (CCI), American Society of Anesthesiologists (ASA) physical status classification score, indication for the use of the ERCP procedure, and clinical outcomes. Then, we tested all variables to identify the potential risk factors for complications associated with the procedure.

Results

The older group (those ≥80 years old) showed significantly more patients with ASA Classes III-IV than the younger one (those ≤79 years old). Interestingly, the CCI was higher in the younger group (p = 0.009). The overall complication rate was 17.3% without inter-group differences. Older age, sex, CCI and intra-ERCP procedures were not related to a higher risk of complications, and the multivariate regression did not identify any of the considered variables to be an independent risk factor for complications.

Conclusion

ERCP appears as safe in the patients aged 80 years and older, as it is in those aged 70–79 years old in our study, however, a selection bias may affect these findings. A study including a comprehensive geriatric assessment will contribute to shedding light on this issue.