Post-operative pancreatitis following ERCP and EST in elderly patients with choledocholithiasis.

Abstract

Objective: Herein, we identified risk factors (RFs) for post-operative pancreatitis among elderly sufferers of choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography (ERCP) along with endoscopic sphincterotomy (EST), and to develop a predictive model for pancreatitis occurrence.

Methods: We retrospectively collected clinical data of elderly patients (≥ 65 years old) with choledocholithiasis undergoing ERCP+EST at Affiliated Liupanshui Hospital of Zunyi Medical University from January 2017 to April 2024. Participants were stratified into pancreatitis and non-pancreatitis cohorts according to their post-operative outcomes.

Results: Using multivariate analysis, we determined stand-along RFs for post-operative acute pancreatitis as follows: Age under 75 years, a history of acute pancreatitis, pancreatography, difficult intubation, and multiple guidewire insertions into the pancreatic duct (p < 0.05). The area under the curve of the predictive model was 0.783 (95% confidence interval: 0.705-0.862), indicating good predictive capability. Calibration curves showed consistency between predicted risks and observed outcomes (Hosmer-Lemeshow test, p > 0.05). Clinical decision curves demonstrated the model's clinical utility.

Conclusions: In elderly patients with choledocholithiasis, factors such as younger age (under 75), history of acute pancreatitis, challenging intubation, pancreatography, and multiple guidewire insertions into the pancreatic duct are significant RFs for post-ERCP pancreatitis.