A retrospective study of the safety and efficacy of ERCP in octogenarians.
BACKGROUND
Pancreatobiliary disease is increased in elderly patients. Because of significant comorbidities, these patients may be at greater risk of developing complications related to endoscopic retrograde cholangiopantreatography (ERCP).


OBJECTIVE
The purpose of this study was to compare the indications, interventions, and complications of ERCP of octogenarians with nonoctogenarians.


METHODS
A retrospective review of patient records from a single tertiary care hospital was performed. Adult patients undergoing ERCP were divided into two groups according to age. Group 1 patients were of age < 80 years (N = 391), and group 2 patients were > 80 years of age (N = 102). Indications, therapeutic interventions, use of conscious sedation, duration of procedure and complications were retrieved from the patient records. Main outcome measurements included: indications, therapeutic interventions, use of conscious sedation, duration of procedure and complications.


RESULTS
There was an increase in sphincterotomy rates (74 vs 63%; P < 0.05) and stent insertions (48 vs 29%; P < 0.001) in the octogenarian group. In group 1 there were 19 cases (4.9%) of post ERCP pancreatitis who spent 251 hospital days (including 59 ICU days) compared with one case (0.98%) in group 2 who required ten hospital days (P < 0.05) and 0 ICU days. Procedure time for octogenarians was greater than nonoctogenarians (33.1 vs 29.8 min; P < 0.05). Octogenarians required less conscious sedation than nonoctogenarians (midazolam 4.1 vs 5.9 mg; P < 0.05 and fentanyl 45.5 vs 80.4 mcg; P < 0.05).


CONCLUSIONS
In octogenarians, ERCP is efficacious and safe. It is associated with a lower rate of hospitalization for pancreatitis. ERCP in octogenarians takes longer, is associated with increased interventions (stent insertion and sphincterotomy) and requires less sedation.
Ali
Massud
M
Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Ward
Greg
G
Staley
Doug
D
Duerksen
Donald R
DR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D016292:Procedural Sedation / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000706:statistics & numerical data; D015607:Stents / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult