Emergency one-stage endoscopic treatment in the older adults with acute cholangitis with choledocholithiasis: a propensity score-matched analysis.

Abstract

Purpose: Current opinions on endoscopic retrograde cholangiopancreatography (ERCP) safety in older patients are contentious. This study aimed to assess emergency one-stage endoscopic treatment for choledocholithiasis-related cholangitis in older adults.

Methods: Patients with choledocholithiasis related cholangitis from January 2019 to July 2023 were recruited. A propensity score (PS) framework was then used to evaluate clinical outcomes after ERCP in patients over 80 years of age.

Results: Inclusion criteria yielded 374 patients, with 120 pairs matched via PS (median age: 85.1 years; 49.2% male in the older group). There was no significant difference in in-hospital mortality between the older adult ERCP group and the control group (2.5% vs. 0%, P = 0.081), whereas intensive care unit (ICU) admissions were higher (38.3% vs. 17.5%, P < 0.001) and length of hospital stay (LOHS) were longer (10 days vs. 8.5 days, P < 0.001). Multivariate analysis revealed that factors affecting LOHS included procalcitonin (PCT), creatinine (Cr), age, and adverse events related to post-ERCP. The independent factor rising ICU admission was age. Subgroup analysis revealed early ERCP reduced antibiotic use and hospitalization in older patients. Severe acute cholangitis (SAC) increased antibiotic use duration and 30-day mortality, while comorbidities raised ICU admission rates, ICU duration, and antibiotic use.

Conclusion: One-stage endoscopic treatment is safe and effective for older patients, with higher age linked to increased ICU admissions. Early ERCP benefits hospital outcomes, feasible even in severe SAC or comorbid conditions.