Endoscopic Retrograde Cholangiopancreatography in Nonagenarian Patients: Is It Really Safe?

Background/Aims: Literature on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients is divided. Based on this we decided to examine the safety of ERCP in nonagenarian patients. Methods: A total of 1,389 patients, with a mean age of $63.94{\pm}19.62$ years, underwent ERCP during the study period. There were 74 patients aged 90 years or older with a mean age of $92.07{\pm}1.8$. Logistic regression showed that nonagenarian patients had a significantly increased odds of in-patient mortality (adjusted odds ratio [AOR]=9.6; 95% confidence interval [CI]=4, 23; $p{\leq}0.001$). Charlson Comorbidity Index $(CCI){\geq}2$ was also an independent predictor of in-patient mortality (AOR=2.4; 95% CI=1.2, 5.2; p=0.021). Age ${\geq}90$ was not associated with increased adverse events; however emergency procedures (AOR=2.4; 95% CI=1.5, 4; p<0.001) and $CCI{\geq}2$ (AOR=2.6; 95% CI=1.7, 4.0; p<0.001) were more likely to have adverse events. Conclusions: Age ${\geq}90$ and $CCI{\geq}2$ are independently associated with increased odds of in-patient mortality in patients undergoing ERCP, whereas emergency procedures and $CCI{\geq}2$ are associated with an increased adverse event rate. Caution must be exercised when considering ERCP in patients aged ${\geq}90$ years and those with a $CCI{\geq}2$.