ERCP efficacy and safety in the very elderly: robust effectiveness with some concerns

Aims With increasing age, the incidence of biliary diseases rises [1] [2]. When performing an ERCP in an elderly patient, the anticipated benefits of endoscopy as well as the increased risks of adverse events (AEs) must be considered. This single-centre observational study aims to retrospectively evaluate the incidence of ERCP-related AEs in a cohort of patients≥80 years old, respect to a control cohort<80 years old.

Methods All consecutive naïve patients who underwent an ERCP from August 2022 to April 2023 in Baggiovara and Policlinico Hospitals (Modena) were enrolled. Intra-procedural (bleeding, perforation, sedation) and post-procedural (bleeding, perforation, pancreatitis, cholangitis, death) AEs were recorded up to 30 days. For the diagnosis and definition of severity of AEs, the following classifications were used: the revised Atlanta classification for pancreatitis, the Cotton Classification for post-sphincterotomy bleeding, the Stapfer classification for perforations, the 2018 Tokyo Guidelines for cholangitis. Death, permanent injury, or endotracheal intubation were considered major AEs.

Results 312 patients were considered eligible for the study: 199 (64%)<80 years old (control group) and 113 (36%)≥80 years old (case group). As expected, cases showed respect to controls, a significantly higher prevalence of female sex (57% vs 42%; p-value 0.010), comorbidities (83% vs 53%; p-value<0.001) and polypharmacotherapy (91% vs 65%; p-value<0.001), in particular anticoagulants (62% vs 36%; p-value<0.001). In elderly there was also a higher incidence of para-Vaterian diverticulum (26% vs 10%; p-value<0.001) and choledocholithiasis (68% vs 51%; p-value 0.013). Incidence of moderate-severe post-sphincterotomy bleeding (4% vs 2%; p-value 0.337) neither moderate-severe pancreatitis (1% vs 2%; p-value 0.929) nor cholangitis (9% vs 7%;0.684) nor sedation AEs (1% vs 1%) was different between the two groups. 5 perforations occurred (3 in≥80 years old): 1 jejunal in a gastroresected patient, 3 induced by decubitus of the stent and 1 related to cannulation. In our series, the 30-day mortality was significantly higher in the elderly (7;7% vs 1;1%; p-value 0.004). In 3 patients death occurred despite the biliary drainage having been effective.

Conclusions ERCP is a safe and effective procedure even in patients≥80 years old. These patients, however, are exposed to a greater risk of morbidity and mortality if AEs occurred.

Publication History

Article published online:
15 April 2024

• References

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