Endoscopic retrograde cholangiopancreatography in elderly patients: Is age just a number or something more?

Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography (ERCP), especially post-ERCP pancreatitis (PEP).

To validate these findings in a large, real-world clinical setting.

Clinical, epidemiological, and procedural data collected from a prospectively maintained database were gathered over a 20-year period (2001-2021) from consecutive patients undergoing their first ERCP. Patients were grouped based on age: < 80 years and ≥ 80 years.

A total of 3147 patients were included in the study, with 70.3% < 80 years old and 28.7% ≥ 80 years. The most common indication for ERCP was biliary colic with or without elevated liver enzymes (39.6%). Periampullary diverticula were more frequently observed in elderly patients (P < 0.001). Successful cannulation of the common bile duct was achieved in 96.1% of cases and did not differ significantly between age groups (P = 0.148). Complete common bile duct clearance during the first ERCP was accomplished in 90.1%, and stone size was the only independent predictor of success. Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding (odds ratio [OR] = 1.333; P = 0.03 and OR = 1.275; P = 0.041, respectively). Overall, post-ERCP complications occurred in 6% of cases, with similar rates between elderly and younger patients. The most common complication was PEP. The incidences of clinical bleeding and PEP did not differ significantly between groups (P = 0.290 and P = 0.128, respectively). Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.

Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP, supporting the procedure's safety and efficacy in this population.