Safety, efficacy and post-endoscopic retrograde cholangiopancreatography survival in nonagenarians: a retrospective cohort study

Abstract

Background

Increasing numbers of older patients with pancreatobiliary disease are undergoing endoscopic retrograde cholangiopancreatography (ERCP). Older patients may be at higher risk of ERCP-related adverse events due to their age and comorbidities; however, data are sparse.

Aims

This study aimed to evaluate long-term mortality, procedural outcomes and safety of ERCP in nonagenarians.

Methods

We retrospectively evaluated consecutive patients aged ≥90 years who underwent ERCP at a tertiary hospital over 12 years. The primary outcome was survival. Secondary outcomes included procedural success and adverse events. Logistic regression was used to analyse procedural outcomes, and factors predictive of survival were identified using a Cox proportional hazard model visualised by Kaplan–Meier plot.

Results

A total of 159 consecutive ERCPs were performed in 115 nonagenarian patients. The mean age of the cohort was 92.3 (standard deviation ± 2.1) years. Choledocholithiasis (78.6%) was the most common indication, followed by malignant biliary obstruction (MBO, 18.9%) and bile leak (2.5%). Survival following ERCP for MBO at 30 days, 3 months and 1 year was 78%, 52% and 9%, respectively, compared to 98%, 94% and 89% for choledocholithiasis (P < 0.001). Procedural success was achieved in 91% of ERCPs (benign or malignant). ERCPs performed for MBO were more likely to fail (P < 0.001). Adverse events occurred in 5% of procedures.

Conclusion

Therapeutic ERCP in select nonagenarians is a clinically relevant intervention for both malignant and benign pathology. Age does not constitute a barrier to the performance of ERCP in appropriately selected patients. Nonagenarians may be counselled for a success and adverse event rate equivocal to younger populations.