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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic retrograde cholangiopancreatography in elderly patients: Is age just a number or something more?
Theodoros A Voulgaris, George Tribonias, Ioannis S Papanikolaou, Georgios P Karamanolis, Ioannis A Vezakis, Aspasia Louta, Orfeas Petros Varvarelis, Leonidas Chardalias, Andreas Polydorou, Antonios Vezakis
Theodoros A Voulgaris, Georgios P Karamanolis, Aspasia Louta, Orfeas Petros Varvarelis, Leonidas Chardalias, Andreas Polydorou, Antonios Vezakis, Department of Endoscopy, Second Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
George Tribonias, Department of Gastroenterology, Red Cross Hospital, Athens 11526, Attikí, Greece
Ioannis S Papanikolaou, Hepatogastroenterology Unit, Department of Second Internal Medicine-Propaedeutic, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens 12462, Greece
Ioannis A Vezakis, Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Zografou Polytechnic Campus, Athens 15772, Attikí, Greece
Author contributions: Vezakis A, Polydorou A, Tribonias G, Louta A, Chardalias L, Varvarelis OP, and Voulgaris TA performed or assisted in endoscopic retrograde cholangiopancreatography procedures; Vezakis A, Tribonias G, Vezakis IA, Louta A, Chardalias L, Varvarelis OP, and Voulgaris TA were implicated in data collection; Voulgaris TA wrote the initial draft; Vezakis A, Karamanolis GP, Papanikolaou IS, and Polydorou A reviewed the manuscript; Vezakis A finalized the manuscript.
Institutional review board statement: Since this was a post hoc analysis of de-identified, previously collected data, ethical approval was not required.
Informed consent statement: Since this study was a retrospective analysis of de-identified previously collected data with no direct link to individual patients, informed consent statement was waived.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Antonios Vezakis, Professor, Department of Endoscopy, Second Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vasilissis Sofias 76, Athens 11528, Greece.
avezakis@hotmail.com
Received: June 4, 2025
Revised: June 27, 2025
Accepted: August 22, 2025
Published online: October 7, 2025
Processing time: 114 Days and 10.3 Hours
BACKGROUND
Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography (ERCP), especially post-ERCP pancreatitis (PEP).
AIM
To validate these findings in a large, real-world clinical setting.
METHODS
Clinical, epidemiological, and procedural data collected from a prospectively maintained database were gathered over a 20-year period (2001-2021) from consecutive patients undergoing their first ERCP. Patients were grouped based on age: < 80 years and ≥ 80 years.
RESULTS
A total of 3147 patients were included in the study, with 70.3% < 80 years old and 28.7% ≥ 80 years. The most common indication for ERCP was biliary colic with or without elevated liver enzymes (39.6%). Periampullary diverticula were more frequently observed in elderly patients (P < 0.001). Successful cannulation of the common bile duct was achieved in 96.1% of cases and did not differ significantly between age groups (P = 0.148). Complete common bile duct clearance during the first ERCP was accomplished in 90.1%, and stone size was the only independent predictor of success. Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding (odds ratio [OR] = 1.333; P = 0.03 and OR = 1.275; P = 0.041, respectively). Overall, post-ERCP complications occurred in 6% of cases, with similar rates between elderly and younger patients. The most common complication was PEP. The incidences of clinical bleeding and PEP did not differ significantly between groups (P = 0.290 and P = 0.128, respectively). Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.
CONCLUSION
Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP, supporting the procedure’s safety and efficacy in this population.
Core Tip: Data suggest that endoscopic retrograde cholangiopancreatography (ERCP) is just as effective in elderly patients as in younger ones and is associated with a lower rate of complications, including post-ERCP pancreatitis. Based on our experience, ERCP in elderly patients is generally as safe and effective as in younger patients. However, when complications do occur, they tend to be more challenging to manage. Additionally, factors such as the use of antiplatelet and anticoagulant medications, the presence of periampullary diverticula, and larger stones, more frequently observed among elderly patients, may pose additional risks, especially for bleeding, and may influence procedural success.
