title: Assessment of safety of non-anesthesiologist-assisted endoscopic retrograde cholangiopancreatography based on performance status in elderly patients.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in the elderly patients, yet little is known concerning objective criteria of safety. This study aimed to determine the potential predictors for the procedure-related outcomes.
  
  
  METHODS
  Two hundred eighty-one patients older than 70 years who were indicated for ERCP (group A [n = 195], 70-79 years of age; group B [n = 86], ≥ 80 years of age) were prospectively enrolled and analyzed for the development of serious adverse events related to ERCP.
  
  
  RESULTS
  ERCP was not performed in six patients at high risk for the procedure. There were significant differences between group A and B in Duke Activity Status Index (DASI) (23.1 vs 14.9, P < 0.01) and Eastern Cooperative Oncology Group performance status (3 and 4, 49/195 vs 33/86, P < 0.05). Major ERCP-related complications (hypotension, severe bradycardia, hypoxia, myocardial infarction, cerebral infarction) occurred in five patients from group B and three from group A. Post-ERCP pancreatitis occurred in one patient from group A and bleeding in one from group B. In univariate analysis, old age (≥ 80 years), American Society of Anesthesiologists score ≥ 3, and DASI < 10 were statistically significant predictors for overall serious events related to ERCP. In the multivariate analysis, DASI < 10 (only manage to ambulate) was independent predictor for overall serious events related to ERCP.
  
  
  CONCLUSIONS
  DASI score is useful predictor for the feasibility assessment of safe ERCP in the elderly patients.
authors.affiliation: Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Park
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Choi
authors.forename: Hyoung-Chul
authors.initials: HC
authors.lastname: Oh
authors.forename: Ju Wan
authors.initials: JW
authors.lastname: Kim
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Do
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Jung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010820:Physicians; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012449:Safety
keywords: elderly; endoscopic retrograde cholangiopancreatography; performance; safety