Endoscopic retrograde cholangiopancreatography in the comorbid elderly: a retrospective comparative study in New Zealand

Abstract

Aim: To ascertain if endoscopic retrograde cholangiopancreatography (ERCP) in the elderly is associated with an increased risk of complications.

Methods: Retrospective study of 509 consecutive ERCPs on 338 patients in one year (2019-2020). Patients were categorised as >75 years old (elderly test group) or ≤75 (controls). The primary outcome was ERCP complications. Secondary outcomes were the length of hospital stay after complications, intensive care admissions, and all-cause mortality at 30 and 90 days.

Results: Forty-four complications occurred in a group of 42 (8%) patients; 11 (2%) were severe, including four deaths. The most common complication was pancreatitis n=33 (6%). There was no difference in complication rates between the elderly and younger controls. Length of stay after complications was similar (median five versus four days; p=0.354). All-cause mortality was higher in the elderly at 30-days (8.5% versus 2%; p=0.002) and 90-days (19.7% versus 6.9%; p=0.001), mostly attributed to malignancy. Logistic analysis showed that neither age >75 years nor Charlson Comorbidity Index (CCI) ≥5 was associated with post-ERCP pancreatitis, but a CCI≥5 strongly increased the odds of death at 90-days (AOR=74.44; 95% confidence interval (CI): 9.78- 566.38, p<0.001).

Conclusion: ERCP is relatively safe in elderly patients, but comorbidities should be considered to avoid subjecting vulnerable individuals with a short life expectancy to unnecessary procedures.