A risk score model for post-endoscopic retrograde cholangiopancreatography complications in elderly patients with choledocholithiasis

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for choledocholithiasis. This study aimed to identify the independent risk factors for post-ERCP complications in elderly patients with choledocholithiasis and establish a risk score model. Methods: This study enrolled patients over the age of 75 with choledocholithiasis, who underwent ERCP at two hospitals. Multivariate logistic regression analysis was used to identify predictive factors and establish a weighted risk score model, which was then externally validated. Results: Five factors (Charlson comorbidity index ≥3, aspartate aminotransferase >the upper limit of normal, endoscopic papillary large balloon dilation, cannulation time >10 min, and multiple large stones) were identified as risk factors for post-ERCP complications. A seven-point score model was established, with a score of three or above considered high risk and less than three considered low risk. The areas under the receiver operating characteristic curve for the derivation and validation cohorts were 0.791 (95% CI, 0.742–0.794) and 0.876 (95% CI, 0.793–0.879), respectively, with sensitivities of 0.755 (95% CI, 0.660–0.831) and 0.901 (95% CI, 0.698–0.972), and specificities of 0.826 (95% CI, 0.791–0.856) and 0.854 (95% CI, 0.761–0.914), respectively. Conclusions: An easy-to-use score model was successfully derived to help predict the risk of post-ERCP complications in elderly patients with choledocholithiasis.