S2244 Feasibility and Safety of ERCP in the Elderly Population – A Propensity-Matched Retrospective Study

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for diagnosing and treating various hepatobiliary conditions. Nevertheless, there exists a paucity of data regarding post-ERCP complications within the elderly demographic. This study aims to investigate post-ERCP outcomes, encompassing adverse events and complications, in patients aged 75 and older. ERCP continues to be studied concerning its safety for elderly individuals. Prior studies have yielded mixed results concerning complications, frequently lacking comprehensive geriatric assessments. Methods: We conducted a retrospective, propensity-matched cohort study using data from the TriNetX research network, involving individuals aged 18 to 89 who underwent ERCP for hepatobiliary conditions. Patients were divided into 2 age cohorts: those under 75 years old and those 75 years and older. We used regression analysis with odds ratios to assess all-cause mortality as the primary outcome. Secondary outcomes included post-ERCP complications like sepsis, septic shock, acute kidney injury, and electrolyte imbalances, and adverse outcomes such as ICU stay, blood product infusion, and bleeding. Results: Mortality rates did not differ significantly (OR 0.94; CI 0.83–1.05) between the 2 groups. Older adults (aged >75 years) exhibited lower odds of developing post-ERCP pancreatitis (PEP) (OR 0.57; CI 0.50–0.66), sepsis (OR 0.85; CI 0.77–0.93), acute kidney injury (OR 0.86; CI 0.79–0.94), hyponatremia (OR 0.61; CI 0.54–0.69), and hypernatremia (OR 0.55; CI 0.42–0.72). Additionally, advanced age correlated with reduced odds of portal vein thrombosis (OR 0.59; CI 0.48–0.73), hyperkalemia (OR 0.62; CI 0.52–0.75), and hypokalemia (OR 0.78; CI 0.70–0.86). In contrast, elderly patients had higher odds of experiencing empyema (OR, 1.94; CI, 1.03–3.61), pneumonia (OR, 1.42; CI, 1.22–1.66), and jaundice (OR, 1.18; CI, 1.09–1.28). ICU admissions (OR 0.23; CI 0.11–0.45) and the need for blood transfusions (OR 0.59; CI 0.50–0.70) were significantly lower among older patients. Conclusion: Elderly patients undergoing ERCP have a lower risk of complications, such as PEP, sepsis, and electrolyte disturbances, with mortality rates comparable to those of younger patients. However, they may experience a higher incidence of respiratory and biliary complications. These findings reinforce the safety of ERCP in older populations but underscore the need for vigilance regarding respiratory and biliary outcomes.