A Single Center Study of Efficacy and Safety Assessment of ERCP in Elderly Patients

Summary

This single-center study indicates that ERCP is a minimally invasive endoscopic procedure that is both safe and effective for older patients.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as a valuable minimally invasive therapeutic method for pancreatobiliary diseases and is now utilized in numerous hospitals. As the population ages, greater attention must be paid to the risk of ERCP complications, since even minor issues can be fatal for older patients. The primary objective of this study was to compare the clinical outcomes of ERCP in elderly versus non-elderly patients, as well as to validate the procedure's safety and feasibility. Additionally, the article provides a detailed, step-by-step description of ERCP procedures to assist in clinical practice. Among the 1,240 patients who underwent ERCP in the past 5 years, over 65.5% were elderly. We compared the perioperative clinical data and success rates of both groups. After thorough preoperative evaluation, the analysis revealed no significant differences in overall success rates or complication rates between elderly and non-elderly patients. These results indicate that ERCP is a safe and effective intervention for elderly patients.

Introduction

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a cornerstone technique for diagnosing and treating biliopancreatic diseases. Compared to surgery, it offers significant advantages, including reduced trauma and direct, effective drainage, making it particularly valuable for managing these conditions in high-risk, frail elderly patients^1,2. With increasing life expectancy and improved healthcare, the demographic challenge of an aging population is prominent in China, leading to a rising proportion of elderly patients undergoing ERCP^3,4. However,....

Protocol

This study was approved by the ethics committees of Shanghai Tong Ren Hospital and Shanghai Jiao Tong University School of Medicine. (Ethics Approval No: A2023-085-01). Written informed consent was obtained from all participants or their legal guardians.

1. Preoperative preparation

1. Conduct a thorough preoperative assessment of the patient's physical condition. This includes a strict evaluation of the indications and contraindications for ERCP.
   1. Use the following inclusion criteria: Patients who require removal of bile duct stones (choledocholithiasis), relief of malignant or benign biliary obstruc....

Results

We retrospectively assembled ERCP cases from the previous 5 years by examining historical and follow-up information to ensure accuracy. From January 2020 to November 2024, a total of 1,240 ERCPs were performed on 1,133 patients aged 16 to 102 years, with a median age of 71. Procedural success was defined as complete stone clearance, adequate stent placement, or resolution of biliary obstruction confirmed by fluoroscopy/cholangioscopy. Among them, 405 patients (438 procedures) were 65 year.......

Discussion

ERCP, being less invasive than surgery, is highly effective in diagnosing and treating biliopancreatic diseases through direct drainage, making it an optimal choice for elderly and frail patients⁸. As minimally invasive treatments become more popular, there has been a notable increase in elderly patients requiring ERCP. This trend is accompanied by rising co-morbidities, increased use of medications such as anticoagulants, and complexities in endoscopic procedures, which together drive a high.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
CleverCut 3V	Olympus Medical	KD-V411M-0725	selective biliary cannulation and papillary sphincterotomy
Duodenoscopy	Olympus Medical	TJF-260V	Endoscopy for ERCP
EyeMAX	Micro-Tech (Nanjing) Co.Ltd	CDS22001	Disposable ultrafine peroral cholangioscope
Flexima Biliary Stent	Boston Scientific	M00539260	Biliary stent drainage
Fusion Extraction Balloon With Multiple Sizing	Cook Medical	G31537	Balloon for clearing bile duct stones
Fusion Titan Biliary Dilation Balloon	Cook Medical	FS-BDB-6X4	Dilatation of the primary papilla
Jagwire High Performance Guidewire	Boston Scientific	M00556580	Guidewire
LithoCrushV Mechanical Lithotriptor	Olympus Medical	BML-V442QR-30	Mesh basket for lithotripsy
Nasal Biliary Drainage Sets	Cook Medical	ENBD-7-LIGUORY	Nasobiliary drainage
Optional repeatable opening and closing of soft tissue clips	Micro-Tech (Nanjing) Co.Ltd	ROCC-D-26-195	Titanium clips
TetraCatch V	Olympus Medical	FG-V432P	Mesh basket for stone removal
Zimmon Pancreatic Stent	Cook Medical	SPSOF-5-5	Pancreatic Duct Stent Drainage