title: ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis.
abstract: OBJECTIVE
  The continually increasing life expectancy in man comes along with an increasing number of endoscopic interventions performed in patients with advanced or even very advanced age. Data on the feasibility and safety of ERCP in elderly patients are relatively scarce.
  
  
  METHODS
  By a systematic query of the University Hospital Frankfurt clinical database, patients undergoing their first ERCP procedure at our center were retrospectively identified. Patients were grouped according to age at the day of the intervention (>80 years, 61-80 years, 40-60 years, and <40 years). Demographic data, indication, outcome, and risk factors were compared among the indicated groups.
  
  
  RESULTS
  A total of 758 patients who underwent ERCP procedures at our center were identified and included in the study. Main indications for ERCP were intraductal gallstones in 345 patients (45%) and tumor obstruction of the bile ducts (distal common bile duct: n = 126 [16.5%], hilar cholangiocarcinoma: n = 89 [11.7%], tumor of papilla of Vater: n = 16 [2.1%]). Gallstones were the most common cause for ERCP in patients aged >80 years (53.8%), and normal findings indicating exclusion of relevant disease were more frequent in patients <80 years (13.4%) compared with older patients (4.3%) (P < .01). Sedation adverse events were significantly more common in individuals aged >80 years compared with younger patients (3.4% vs 0.5%; P < .01). However, post-ERCP pancreatitis was significantly less frequent in the older patients (>80 years) (0.9% vs 5.3%; P < .05). Other adverse events were equally distributed in all age groups. The ERCP success rate (>80%) was not different among age groups.
  
  
  CONCLUSIONS
  ERCP is safe and efficient in patients aged 80 years or older. However, conscious sedation must be carefully monitored in older patients because risk of sedation adverse events is increased. The incidence of post-ERCP pancreatitis is lower in older patients compared with younger ones.
authors.affiliation: Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Finkelmeier
authors.affiliation: Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tal
authors.affiliation: Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany.
authors.forename: Mariam
authors.initials: M
authors.lastname: Ajouaou
authors.affiliation: Institute of Biostatistics and Math Modeling, Faculty of Medicine, J.W. Goethe University, Frankfurt, Germany.
authors.forename: Natalie
authors.initials: N
authors.lastname: Filmann
authors.affiliation: Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Waidmann
authors.affiliation: Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Albert
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors