Endoscopic retrograde cholangiopancreatography in elderly patients: Is age just a number or something more?

Background: Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography (ERCP), especially post-ERCP pancreatitis (PEP).

Aim: To validate these findings in a large, real-world clinical setting.

Methods: Clinical, epidemiological, and procedural data collected from a prospectively maintained database were gathered over a 20-year period (2001-2021) from consecutive patients undergoing their first ERCP. Patients were grouped based on age: < 80 years and ≥ 80 years.

Results: A total of 3147 patients were included in the study, with 70.3% < 80 years old and 28.7% ≥ 80 years. The most common indication for ERCP was biliary colic with or without elevated liver enzymes (39.6%). Periampullary diverticula were more frequently observed in elderly patients (P < 0.001). Successful cannulation of the common bile duct was achieved in 96.1% of cases and did not differ significantly between age groups (P = 0.148). Complete common bile duct clearance during the first ERCP was accomplished in 90.1%, and stone size was the only independent predictor of success. Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding (odds ratio [OR] = 1.333; P = 0.03 and OR = 1.275; P = 0.041, respectively). Overall, post-ERCP complications occurred in 6% of cases, with similar rates between elderly and younger patients. The most common complication was PEP. The incidences of clinical bleeding and PEP did not differ significantly between groups (P = 0.290 and P = 0.128, respectively). Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.

Conclusion: Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP, supporting the procedure's safety and efficacy in this population.