title: Combined ERCP and EUS in one session is safe in elderly patients when compared to non-elderly patients: outcomes in 206 combined procedures.
abstract: OBJECTIVE
  Combined ERCP/EUS is becoming common. Combined procedures are frequently performed in elderly patients. We hypothesized that combined ERCP/EUS is equally safe in elderly patients when compared to non-elderly patients.
  
  
  METHODS
  This was a retrospective single-center study comparing outcomes in elderly and non-elderly patients undergoing combined ERCP/EUS.
  
  
  RESULTS
  A total of 206 patients were included. Mean age was 65 years (M:F 113:93); 99 were <65 years and 107 were >65. Indications included: jaundice (51%), abnormal imaging (17%), pancreatic tumor (11%), abdominal pain (5%), stent placement/change (5%), acute or chronic pancreatitis (5%), other (6%). Fine needle aspiration was performed in 134 (65%) procedures. Malignancy was identified in 142/206 (69%) patients. Mean Charlson Comorbidity Index (CCI) was 7.5 (range 0-22). Among patients <65 years old there were no immediate adverse events. Long-term adverse events in patients <65 (within 30 days) included cholangitis (1), increasing abdominal pain (4), post-ERCP pancreatitis (3), nausea/vomiting (1), increasing fatigue (1), and increasing jaundice (1). A subgroup analysis among geriatric patients (>65) was performed. Mean CCI was 8.2 (range 0-22). There was one immediate adverse event of non-sustained ventricular tachycardia in a 76-year old. Long-term adverse events included increasing fatigue (1), nausea/vomiting (2), increasing abdominal pain (2), urosepsis (1), fever (2) and dehydration (1). There were no statistically significant differences in outcomes in elderly compared to non-elderly patients. Elderly patients had higher CCI scores (p = 0.04).
  
  
  CONCLUSIONS
  Combined ERCP/EUS in one session is safe in the general population and elderly patients, with no more adverse events than in non-elderly patients.
authors.affiliation: Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
authors.forename: Lulu
authors.initials: L
authors.lastname: Iles-Shih
authors.forename: Kristen
authors.initials: K
authors.lastname: Hilden
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology; D019160:Endosonography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007565:Jaundice / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000000981:diagnostic imaging; D061214:Patient Safety; D012189:Retrospective Studies