ERCP in very elderly -treat or threat?

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Aims Endoscopic interventions in the elderly are increasing due to the ongoing rise in life expectancy. Data about the safety of ERCP in the elderly are limited. Methods Patients who underwent ERCP at the University Gastroenterology Department of Ioannina during a 2-year-period of time, were retrospectively studied. Demographics, indications, and outcomes were recorded in terms of age at the time of ERCP (>85 years, 61-85 years, 40-60 years, and <40 years). Results 530 patients who underwent ERCP at our center in the last 2 years were studied, 20.7% (n=110) were >85 years old, 56.0% were 61-85, 21.5% among 40-60 and only 1.6% <40 years. Choledocholithiasis (44.5%), pancreatic tumor (18.1%), cholangiocarcinoma (10.3%), ampulla tumor (1.5%), and benign CBD stenosis (5%) were the main reasons for ERCP. Choledocholithiasis was the most common reason for ERCP in all studied groups, followed by malignancies. The dose of intravenous sedative agents was lower in >85-years-old group. Post-ERCP pancreatitis was less common in the very elderly (2.7% in >85 years vs. 3.7% in 61-85 and 8.7% in 40-60), but cholangitis, hemorrhage, and perforation were equally distributed in all groups. ERCPs were successful across all age groups. In 70% of patients >85 with choledocholithiasis, a stent was left and a second ERCP was performed for cleaning or replacement. Conclusions ERCP is a safe and effective intervention in elderly. However, sedation and anaesthesia should be particularly monitored in this group. The risk of post-ERCP pancreatitis is reduced in older patients compared to younger age groups. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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