Unsedated emergent ERCP is feasible and efficient for acute cholangitis in old patients over 80 years

Acute cholangitis in elderly patients poses unique challenges due to comorbidities and frailty, necessitating timely intervention. This study evaluates the feasibility and efficiency of unsedated emergent endoscopic retrograde cholangiopancreatography (ERCP) in patients over 80 years with acute cholangitis.

A retrospective analysis of elderly patients (≥ 80 years) presenting with acute cholangitis who underwent unsedated emergent ERCP between January 2020 and December 2023 was conducted. Data of patients' clinical characteristics, procedural success rates, adverse events, hospital stays, 30-day mortality and 6-month recurrence were collected and analyzed.

Out of 138 elderly patients included, 128 (92.7%) underwent successful unsedated emergent ERCP procedures. 6 patients had ERCP aborted due to patients' intolerance. 5 (3.1%) patients developed mild post-ERCP pancreatitis. The hospital stays were significantly shorter in patients with successful ERCP (6 days (4,8.5) VS 8.5 days (8,11), P = 0.022). 2 patients died after successful ERCP. 29 (22.7%) patients had recurrence within 6 months and univariate logistic regression analysis indicated patients who had concurrent pancreatitis and cholecystitis had less recurrence (OR 0.125, 95% CI 0.016-0.971).

Unsedated emergent ERCP appears to be a viable option for managing acute cholangitis in elderly patients over 80 years, offering efficient biliary decompression with acceptable safety profiles. Further prospective studies are warranted to validate these findings and optimize management strategies for this vulnerable population.