Endoscopic retrograde cholangiopancreatography in the elderly: Trends, demographic variations, complications, and outcomes

Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Gastroenterol


Introduction: With increasing life expectancy, a higher number of elderly patients are undergoing endoscopic retrograde cholangiopancreatography (ERCP). Adverse events in the general population from ERCP range from 5%-10% and mortality rates range from 0.3% to 0.5%. While epidemiological data and complication rates of ERCP in the general population have been well studied, limited data exists with respect to the elderly population. Methods: We analyzed the national inpatient sample (NIS) database for all hospitalized patients who had undergone an ERCP from 2005 to 2014. We then utilized the Cochran-Armitage trend test and multivariate survey logistic regression to analyze trends, demographic variations, predictors, and outcomes. Results: We compared 647,818 patients older than 65 years to 792,825 patients younger than 65 years. Amongst elderly patients who had undergone an ERCP, the number of hospitalizations increased from 53,972 in 2005 to 74,940 in 2014. Similar trend was seen in patients younger than 65 years (Figure 1). The mean age of patients above 65 years was 77.5 years, out of which 44.7% were male and 55.3% were female (Table 1). The mean length of stay was 7.48 days in patients above 65 years but only 6.24 days in patients younger than 65 years. A lesser number of elderly patients had an emergent ERCP than younger patients (22.8% vs 23.2%; P < 0.0001) (Table 1). Post-ERCP pancreatitis was higher in younger patients than elderly patients (6.14% vs 9.44%; P< 0.0001) (Table 1). Perforation rates were higher in the elderly patients (0.17% vs 0.12%; P < 0.0001) and more elderly patients had ERCP related hemorrhage when compared to younger patients (1.44% vs 1.07; P < 0.0001) (Table 1). Also, the rate of post-ERCP cholecystitis was higher in elderly patients (2.25% vs 2.23%; P < 0.0001). Majority of the elderly patients were discharged home (76.9%), but the all-cause mortality rate was higher in elderly patients undergoing ERCP than younger patients (2.5% vs 0.9%; P < 0.0001) (Table 1). Conclusion: Our analysis showed that the hospitalization rate of elderly patients undergoing an ERCP increased from 2005 to 2014. Elderly patients undergoing ERCP had a longer mean length of stay and allcause mortality than younger patients. Moreover, except post-ERCP pancreatitis, elderly patients had significantly higher rates of ERCP-related complications than younger patients. (Table Presented).

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