Endoscopic Retrograde Cholangiopancreatography in Nonagenarian Patients: Is It Really Safe?
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Background/Aims: Literature on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients is divided. Based on this we decided to examine the safety of ERCP in nonagenarian patients. Methods: A total of 1,389 patients, with a mean age of 63.94±19.62 years, underwent ERCP during the study period. There were74 patients aged 90 years or older with a mean age of 92.07±1.8. Logistic regression showed that nonagenarian patients had asignificantly increased odds of in-patient mortality (adjusted odds ratio [AOR]=9.6; 95% confidence interval [CI]=4, 23; p≤0.001). Charlson Comorbidity Index (CCI) ≥2 was also an independent predictor of in-patient mortality (AOR=2.4; 95% CI=1.2, 5.2;p=0.021). Age ≥90 was not associated with increased adverse events; however emergency procedures (AOR=2.4; 95% CI=1.5, 4;p<0.001) and CCI ≥2 (AOR=2.6; 95% CI=1.7, 4.0; p<0.001) were more likely to have adverse events. Conclusions: Age ≥90 and CCI ≥2 are independently associated with increased odds of in-patient mortality in patients undergoingERCP, whereas emergency procedures and CCI ≥2 are associated with an increased adverse event rate. Caution must be exercised whenconsidering ERCP in patients aged ≥90 years and those with a CCI ≥2.
Abstract
Background/Aims: Literature on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients is divided. Based on this we decided to examine the safety of ERCP in nonagenarian patients. Methods: A total of 1,389 patients, with a mean age of 63.94±19.62 years, underwent ERCP during the study period. There were74 patients aged 90 years or older with a mean age of 92.07±1.8. Logistic regression showed that nonagenarian patients had asignificantly increased odds of in-patient mortality (adjusted odds ratio [AOR]=9.6; 95% confidence interval [CI]=4, 23; p≤0.001). Charlson Comorbidity Index (CCI) ≥2 was also an independent predictor of in-patient mortality (AOR=2.4; 95% CI=1.2, 5.2;p=0.021). Age ≥90 was not associated with increased adverse events; however emergency procedures (AOR=2.4; 95% CI=1.5, 4;p<0.001) and CCI ≥2 (AOR=2.6; 95% CI=1.7, 4.0; p<0.001) were more likely to have adverse events. Conclusions: Age ≥90 and CCI ≥2 are independently associated with increased odds of in-patient mortality in patients undergoingERCP, whereas emergency procedures and CCI ≥2 are associated with an increased adverse event rate. Caution must be exercised whenconsidering ERCP in patients aged ≥90 years and those with a CCI ≥2.
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