John T. Walker, DO1, Ruchit Shah, DO1, Sunny Patel, DO1, Harshit S. Khara, MD, FACG1, David L. Diehl, MD2, Bradley Confer, DO1
1Geisinger Medical Center, Danville, PA; 2Geisinger Health System, Danville, PA
Introduction: Limited data exists regarding safety of ERCP in elderly patients, particularly nonagenarians. Anecdotal experience suggests technical difficulty of ERCP in elderly patients may be increased by anatomic abnormalities such as large hiatal hernia and peri-ampullary diverticula. Several small studies suggest increased ERCP-related adverse effects in the elderly. We aim to evaluate the safety and difficulty of ERCP in nonagenarians compared to a younger cohort of patients.
Methods: A prospectively maintained endoscopy database was queried for patients age ≥ 90 years and patients age 40-69 years undergoing ERCP from 2013 to 2018. One hundred eleven nonagenarian patients who underwent 165 procedures were identified. One hundred eleven patients from a potential 1,982 patients in the younger cohort were randomly selected. Of the 111 patients included in the younger cohort, 205 ERCPs were performed. Outcomes were compared using student’s t-tests for continuous variables and Fisher’s Exact tests for categorical variables. A general estimating equation was utilized to calculate odds ratio comparing the groups by outcome.
Results: The mean age in the nonagenarian cohort was 92.4 (+/- 2.2 ) years compared to 51.4 (+/- 14.3) years for the young patients. In the elderly group, 37 (33%) were male compared to 40% (N=44) for the young patients. The most common indication for ERCP was choledocholithiasis (38% nonagenarian vs. 24% young). There was no difference in difficulty passing the duodenoscope between the older group (7.3%) and young group (7.7%), OR 0.93 [0.35, 2.48], P=0.88. There was a higher rate of peri-ampullary diverticula in nonagenarians (16.4%) compared to young patients (3.4%), OR 5.53 [1.45, 21.15], P=0.01. There was no statistical difference in failed cannulation for the elderly group (5.5%) vs. the young group (2.9%), OR 1.91 [0.61, 6.00], P=0.27) or need for pre-cut access in the elderly cohort (10.9%) vs. the young group (8.3%), OR 1.67 [0.37, 7.53], P=0.50. Most importantly, there was no difference in adverse events between nonagenarians (9.1%) and younger patients (9.3%), OR 0.98 [0.49, 1.94], P=0.60).
Discussion: Despite perceived increased risk and difficulty performing ERCP in nonagenarians, our data demonstrate success rate and number of adverse events of ERCP is similar to younger patients. Based on this data, reasonable informed consent can be given regarding the safety and technical success of ERCP in nonagenarians.
Citation: John T. Walker, DO; Ruchit Shah, DO; Sunny Patel, DO; Harshit S. Khara, MD, FACG; David L. Diehl, MD; Bradley Confer, DO. P0034 - OUTCOMES AND SAFETY OF ERCP IN NONAGENARIANS COMPARED TO A YOUNGER COHORT. Program No. P0034. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.