Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography for the Longevous Population

There are presently limited clinical studies of endoscopic retrograde cholangiopancreatography (ERCP) in the longevous (elders aged no less than 90 years old). This study aimed to evaluate the efficacy and safety of ERCP in longevous patients.

A total of 113 longevous patients who underwent ERCP for the first time at our center from January 8^th, 2009 to December 20^th, 2023 were enrolled. Correspondingly, the control groups included the old-old (75-89 years) patient group and the young-old (60-74 years) patient group. Each of the control group was matched in a 1:2 ratio to the longevous patient group based on the gender, presence of choledocholithiasis, endoscopic sphincterotomy, endoscopic papillary balloon dilatation, periampullary diverticulum, the placement of biliary stent, and guidewire entry into the pancreatic ducts, ultimately including 226 patients in each control group. Baseline characteristics, clinical and endoscopic data were compared among the three groups, and risk factors for post-ERCP pancreatitis in elderly patients were analyzed.

Except for the higher incidence of acute cholangitis and atrial fibrillation (AF) in longevous patients, the three elderly patient groups were comparable in baseline characteristics. The technical success rate of ERCP in longevous patients was 95.6%, which has no significant difference from that of old-old patients (95.1%) and young-old patients (96.9%) during the same period. The overall incidence of post-ERCP adverse events was 12.9%, and there was no significant difference in the incidence and mortality of adverse events among the three groups. PEP was the most common adverse event after ERCP in elderly patients. Multivariable logistic regression analysis showed endoscopic metal biliary endoprothesis (OR=2.351, 95% CI 1.144-4.832, P=0.020), pancreatic duct opacification (OR=5.774, 95% CI 1.062-31.383, P=0.042) were independent risk factors for PEP in elderly patients.

ERCP is safe and effective in the longevous population, and advanced age did not increase the incidence of adverse events after ERCP.