Adverse Events of Single Balloon Enteroscopy-assisted Endoscopic Retrograde Cholangiopancreatography in the Elderly: A Propensity Score Matching Analysis

Background

Sedation for conventional endoscopic retrograde cholangiopancreatography (ERCP) has been reported to be safe even for elderly patients. However, the safety of sedation for balloon enteroscopy-assisted ERCP (BE-ERCP) has not been well-studied in the elderly.

Methods

We retrospectively analyzed consecutive patients with surgically altered anatomy who underwent their initial BE-ERCP using midazolam and pethidine at our institution between January 2016 and December 2022. The primary outcome was the rate of cardiopulmonary complications, including hypotension, bradycardia, tachycardia, and hypoxemia. Secondary outcomes included the rates of procedural interruptions, delayed arousal, postprocedural falls, and delirium, dose of sedatives, and rate of ERCP-related adverse events (AEs). Risk factors for cardiopulmonary complications and ERCP-related AEs were also examined.

Results

A total of 190 patients were included (elderly group: 63; non-elderly group: 127). After propensity score matching, 55 patients were selected for each group. The total dose of midazolam was significantly lower in the elderly group (4 mg vs. 5 mg, p = 0.033). Rates of cardiopulmonary complication (11% vs. 11%, p > 0.999) and ERCP-related AEs (6% vs. 9%, p = 0.716) were not significantly different between the two groups. The total dose of pethidine (> 35 mg) and total procedure time (≥ 51 min) were identified as risk factors for cardiopulmonary complications and ERCP-related AEs, respectively.

Conclusions

Cardiopulmonary complications and ERCP-related AEs were similar in elderly and non-elderly patients undergoing BE-ERCP. With careful monitoring, sedation during BE-ERCP appeared safe, even for elderly patients.