Abstract
Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.
Highlights
Nowadays, the life expectancy of the elderly has been increasing and our population is getting older
Patients admitted to the hospital at least 1 day after the Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure were included to the study
Patients admitted to the hospital within 1 day of the ERCP procedure (n 1372) were included in the study, while 1530 patients were excluded due to missing data
Summary
The life expectancy of the elderly has been increasing and our population is getting older. Since the prevalence of pancreaticobiliary disease increases with age, indications for ERCP increase in elderly. Individual decisions should be made about the ERCP since age-related diseases and co-morbidities including pulmonary and cardiac dysfunction might have impact on final outcome. The ERCP procedure related significant risk might outweigh the benefits. According to several prospective series, the overall complication rate of ERCP or sphincterotomy, is about 5–10%4–7. The five independent risk factors for PEP include precut sphincterotomy, sphincter of Oddi dysfunction (SOD), cirrhosis (patient-related factors), percutaneous-endoscopic procedure (method-related factors), and difficult cannulation 8. The risk of ERCP related complications is not enhanced by the advanced age, as shown by multivariate a nalyses. In several case control studies there was no relation between old age or coexisting medical conditions and complication rate of ERCP, except liver cirrhosis
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