Digestive Diseases and Sciences

, Volume 61, Issue 11, pp 3302–3308 | Cite as

Safety and Efficacy of Acute Endoscopic Retrograde Cholangiopancreatography in the Elderly

  • Mika Ukkonen
  • Antti Siiki
  • Anne Antila
  • Tuula Tyrväinen
  • Juhani Sand
  • Johanna Laukkarinen
Original Article



Endoscopic retrograde cholangiopancreatography (ERCP) is a frequent procedure in elderly patients.


We aimed to determine the safety and efficacy of acute ERCP in older patients.


A prospectively managed, hospital-based registry containing all ERCP procedures and complications at a tertiary referral center was used to form the study population, which consisted of consecutive elderly (≥65 years) patients undergoing acute ERCP during the 5-year study period. Indications, details, outcome, and complications of the procedure were analyzed in relation to patient age, gender, and co-morbidities.


A total of 480 elderly patients (median age 78; range 65–97; 48 % men) underwent 531 ERCPs during the study period. The most common indications were bile duct stones (56.1 %) and biliary obstruction caused by malignancy (33.7 %). Successful stone extraction was achieved in 72.8 %, and with an additional, planned ERCP in 96.6 % of the patients. Post-ERCP complications developed in 3.4 % of the patients. These included pancreatitis in 1.7 %, hemorrhage in 0.6 %, and duodenal perforation in 0.2 % of the patients. One of these (0.2 %) was considered severe as this patient required invasive treatments and prolonged hospital stay. The risk of complications was associated with chronic obstructive pulmonary disease and difficult cannulation. Procedure-related mortality was zero, but overall 30-day mortality was 10 %, being 24 % in the patients with malignancy.


ERCP can be safely and efficaciously performed on elderly patients. The high mortality should be taken into consideration when selecting therapeutic options.


Endoscopic retrograde cholangiopancreatography ERCP Morbidity Mortality Aged Elderly 



This study was financially supported by the Competitive Research Funding of the Pirkanmaa Hospital District, Finland.

Compliance with ethical standards

Conflict of interest

All authors disclosed no financial relationships relevant to this publication.


  1. 1.
    Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: management and outcomes. Gut. 1997;41:433–435.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Mazen Jamal M, Yoon EJ, Saadi A, et al. Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol. 2007;102:966–975.CrossRefPubMedGoogle Scholar
  3. 3.
    Halttunen J, Meisner S, Aabakken L, et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol. 2014;49:752–758.CrossRefPubMedGoogle Scholar
  4. 4.
    Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.CrossRefPubMedGoogle Scholar
  5. 5.
    Christensen K, Doblhammer G, Rau R, et al. Ageing populations: the challenges ahead. Lancet. 2009;374:1196–1208.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102:1781–1788.CrossRefPubMedGoogle Scholar
  7. 7.
    Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc. 2006;64:899–905.CrossRefPubMedGoogle Scholar
  8. 8.
    Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older. Gastrointest Endosc. 2006;63:417–423.CrossRefPubMedGoogle Scholar
  9. 9.
    Rodriguez-Gonzalez FJ, Naranjo-Rodriguez A, Mata-Tapia I, et al. ERCP in patients 90 years of age and older. Gastrointest Endosc. 2003;58:220–225.CrossRefPubMedGoogle Scholar
  10. 10.
    Lukens FJ, Howell DA, Upender S, Sheth SG, Jafri SM. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci. 2010;55:847–851.CrossRefPubMedGoogle Scholar
  11. 11.
    Grönroos JM, Salminen P, Laine S, Gullichsen R. Feasibility of ERCP procedures in patients 90 years of age and older. J Clin Gastroenterol. 2010;44:227–228.CrossRefPubMedGoogle Scholar
  12. 12.
    Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000;52:187–191.CrossRefPubMedGoogle Scholar
  13. 13.
    Finkelmeier F, Tal A, Ajouaou M, et al. ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis. Gastrointest Endosc. 2015;82:1051–1059.CrossRefPubMedGoogle Scholar
  14. 14.
    Garcia CJ, Lopez OA, Islam S, et al. Endoscopic retrograde cholangiopancreatography in the elderly. Am J Med Sci. 2016;351:84–90.CrossRefPubMedGoogle Scholar
  15. 15.
    ASGE Standards of Practice Committee, Anderson MA, Fisher L, et al. Complications of ERCP. Gastrointest Endosc. 2012;75:467–473.CrossRefGoogle Scholar
  16. 16.
    Day LW, Lin L, Somsouk M. Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis. Endosc Int Open. 2014;2:28–36.CrossRefGoogle Scholar
  17. 17.
    Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425–434.CrossRefPubMedGoogle Scholar
  18. 18.
    Williams EJ, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007;39:793–801.CrossRefPubMedGoogle Scholar
  19. 19.
    Wang P, Li ZS, Liu F, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009;104:31–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Dumonceau JM, Tringali A, Blero D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44:277–298.CrossRefPubMedGoogle Scholar
  21. 21.
    Walter D, van Boeckel PG, Groenen MJ, et al. Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial. Gastroenterology. 2015;149:130–138.CrossRefPubMedGoogle Scholar
  22. 22.
    Adler DG, Baron TH, Davila RE, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62:1–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Kaffes AJ, Hourigan L, De Luca N, et al. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc. 2005;61:269–275.CrossRefPubMedGoogle Scholar
  24. 24.
    Sandha GS, Bourke MJ, Haber GB, et al. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc. 2004;60:567–574.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mika Ukkonen
    • 1
  • Antti Siiki
    • 1
  • Anne Antila
    • 1
  • Tuula Tyrväinen
    • 1
  • Juhani Sand
    • 1
  • Johanna Laukkarinen
    • 1
  1. 1.Department of Gastroenterology and Alimentary Tract SurgeryTampere University HospitalTampereFinland

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