Safety and Efficacy of Acute Endoscopic Retrograde Cholangiopancreatography in the Elderly
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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.
KeywordsEndoscopic 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.