Efficacy and safety of therapeutic ERCP in patients 90 years of age and older

• Published in: Gastrointestinal endoscopy 2006-03, Vol.63 (3), p.417-423
• Main Authors: Katsinelos, Panagiotis, Paroutoglou, George, Kountouras, Jannis, MD, PhD, Zavos, Christos, Beltsis, Athanasios, Tzovaras, George
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Bile Duct Diseases - complications; Bile Duct Diseases - diagnostic imaging; Bile Duct Diseases - surgery; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cohort Studies; Digestive system; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Health Status; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Pancreatic Diseases - complications; Pancreatic Diseases - diagnostic imaging; Pancreatic Diseases - surgery; Postoperative Complications - epidemiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.09.051

Background Therapeutic ERCP has an established role in the treatment of pancreatobiliary diseases, but little information is available on the outcomes of this procedure in patients 90 years of age and older. Objective To evaluate the efficacy and the safety of therapeutic ERCP in an extremely elderly cohort. Design Retrospective study. Setting Two Greek cohorts of patients ≥90 and 70 to 89 years of age who underwent therapeutic ERCPs. Patients Sixty-three patients aged 90 years and older (group A) and 350 patients 70 to 89 years of age (group B). Interventions A retrospective review of therapeutic ERCPs was performed between 1994 and 2000 on both groups, identified by using a database linked to the endoscopy reporting system in our department. Main Outcome Measurements Efficacy and safety of therapeutic ERCPs. Concomitant diseases, complications, and outcome were also evaluated. Results Group A patients had a higher incidence of concomitant diseases than group B patients (100% vs 72.8%, respectively). The rate of post-ERCP early complications was low in both groups: 6.3% in group A and 8.4% in group B. The frequency of ERCP-related mortality was 1.6% (1 patient) in group A and 0.6% (2 patients) in group B. Group A required endoscopic sessions for stone clearance and mechanical lithotripsy more frequently than group B (20.6% vs 11.4% and 17.5% vs 10.3%, respectively). No patient in either group experienced subjective deterioration in mental status, and the 3 patients who died required ventilatory support before death. Late complications occurred in 2.3% of patients in group B. Conclusions Therapeutic ERCP is safe and effective for the treatment of pancreatobiliary diseases in extremely elderly patients, and advanced age per se should not impinge on decisions relating to its use.