Endoscopic retrograde cholangiopancreatography in elderly patients: Is age just a number or something more?

Table 1 Epidemiological characteristics, anatomical characteristics and endoscopic retrograde cholangiopancreatography indications in the total cohort and comparison of different age groups, n (%)

	Total cohort	< 80 age old (n = 2245)	≥ 80 (n = 902)	P value
Sex (male/female)	1541 (49)/1606 (51)	1125 (49.9)/1120 (50.1)	416 (46.1)/486 (53.9)	0.044
Age [mean ± SD (min-max)] (years old)	68 ± 16 (17-101) (skewness: -0.892 and kurtosis: 0.282)	62 ± 15 (17-79)	85 ± 4 (80-101)
ASA score				< 0.001
1	540 (17.2)	533 (23.7)	7 (0.8)
2	1611 (51.2)	1228 (54.7)	383 (42.5)
3	984 (31.3)	480 (21.4)	504 (55.9)
4	12 (0.4)	4 (0.2)	8 (0.9)
Antiplatelet use	242 (7.7)	141/2245 (6.3)	101/902 (11.2)	< 0.001
Anticoagulant use	181 (5.8)	95/2245 (4.2)	86/902 (9.5)	< 0.001
Indication				< 0.001
Cholangitis	386 (12.3)	202 (9.0)	184 (20.4)
Obstructive jaundice	910 (28.9)	658 (29.3)	252 (27.9)
Biliary colic	1247 (39.6)	920 (41.0)	327 (36.3)
Pancreatitis	315 (10)	226 (10.1)	89 (9.9)
Bile leak	139 (4.4)	120 (5.3)	19 (2.1)
Asymptomatic choledocholithiasis	150 (4.8)	119 (5.3)	31 (3.4)
Previous gastrectomy	76/3147 (2.4)	46/2245 (2.0)	30/902 (3.3)	0.040
Previous hepatobiliary operation	970/3147 (30.8)	723/2245 (32.2)	247/902 (27.4)	0.008
Periampullary diverticula (among patients in whom Vater ampulla was reached)	617/3085 (20)	374/2205 (17.0)	243/880 (27.6)	< 0.001
Papilla abnormalities (inflamed, impacted stone or adenoma)	501/3040 (16.5)	368/2173 (16.9)	133/867 (15.3)	0.304

ASA: American Society of Anesthesiologists.

Table 2 Endoscopic retrograde cholangiopancreatography metrics, technics, and findings according to age group, n (%)

	Total cohort	< 80 age old	≥ 80	P value
Inability to locate or reach the ampulla	107/3147 (3.4)	72/2245 (3.2)	35/902 (3.9)	0.384
Successful cannulation	2291/3040 (96.1)	2095/2173 (96.4)	823/867 (95.3)	0.148
Attempts to cannulate				0.291
< 5	1296/3040 (42.6)	913/2173 (42)	383/867 (44.2)
≥ 5	1744/3040 (57.4)	1260/2173 (58)	484/867 (55.8)
Needle-knife use				0.480
Yes	1136/3040 (37.4)	821/2173 (37.8)	315/867(36.3)
No	1904/3040 (62.6)	1352/2173 (62.2)	552/867 (62.7)
Catheterization of the pancreatic duct				0.012
Yes	1095/3040 (36.0)	813/2173 (37.4)	282/867 (32.5)
No	1945/3040 (64.0)	1360/2173 (62.6)	585/867 (67.5)
Stricture in the cholangiogram				0.063
Yes	701/3040 (23.1)	521/2173 (24.0)	180/867 (20.8)
No	2339/3040 (76.9)	1652/2173 (76.0)	687/867 (79.2)
Normal common bile duct in the cholangiogram	210/2921 (7.2)	171/2095 (8.2)	39/826 (4.7)	< 0.001

Table 3 Factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis development

	Pancreatitis development, n (%)	P value, univariate (χ2 test or Fisher’s exact test, as appropriate)	P value, multivariate binary logistic regression analysis	Multivariate binary logistic regression analysis, objective risk (95%CI)
Elderly patients	11/910 (1.4)	0.129
Non-elderly patients	53/2245 (2.4)
Sex		0.135	0.114	1.498 (0.907-2.475)
Male	26/1541 (1.7)
Female	40/1606 (2.5)
ASA		0.183
1-2	49/2151 (2.3)
3-4	17/996 (1.7)
Normal common bile duct		0.023	0.037	1.808 (1.091-1.959)
Yes	10/210 (4.8)
No	54/2711 (2.0)
Attempts in order to cannulate		< 0.001	0.018	2.015 (1.129-3.596)
< 5	12/1296 (0.9)
≥ 5	54/1744 (3.1)
Needle knife use		< 0.001	0.018	2.381 (1.159-4.891)
Yes	41/1136 (3.6)
No	25/1904 (1.3)
Successful cannulation		0.708
Yes	64/2921 (2.2)
No	2/119 (1.7)
Common bile duct stenting		0.239
Yes	27/1034 (2.6)
No	39/2006 (1.9)
Catheterization of the pancreatic duct		0.026	0.280	1.320 (0.797-2186)
Yes	32/1100 (2.9)
No	34/2047 (1.7)
Periampulary diverticula		0.876
Yes	12/592 (2.0)
No	54/2448 (2.2)

ASA: American Society of Anesthesiologists; CI: Confidence interval.