Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 2988-2999
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.2988
Endoscopic retrograde cholangiopancreatography in elderly patients: Difficult cannulation and adverse events
Fatema Tabak, Hui-Shan Wang, Quan-Peng Li, Xian-Xiu Ge, Fei Wang, Guo-Zhong Ji, Lin Miao
Fatema Tabak, Hui-Shan Wang, Quan-Peng Li, Xian-Xiu Ge, Fei Wang, Guo-Zhong Ji, Lin Miao, Institute of Digestive Endoscopy and Medical Centre for Digestive Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Author contributions: Tabak F and Li QP designed the study; Tabak F, Wang HS, Ge XX, and Wang F recorded and analyzed the data; Tabak F and Miao L drafted the initial manuscript; Tabak F, Ji GZ and Miao L revised the article critically for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Nanjing Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lin Miao, MD, PhD, Chief Doctor, Professor, Institute of Digestive Endoscopy and Medical Center for Digestive Disease, Second Affiliated Hospital of Nanjing Medical University, No. 121, Jiangjiayuan Road, Nanjing 210011, Jiangsu Province, China. linmiao@njmu.edu.cn
Received: March 6, 2020
Peer-review started: March 6, 2020
First decision: April 12, 2020
Revised: May 26, 2020
Accepted: June 19, 2020
Article in press: June 19, 2020
Published online: July 26, 2020
ARTICLE HIGHLIGHTS
Research background

Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable therapeutic technique for pancreatobiliary diseases, and its application in the elderly is no longer limited. However, a higher incidence of procedure difficulty and periprocedural adverse events might be expected in elderly patients due to the presence of other medical disorders and the poor general condition of this population.

Research motivation

The risk of choledocholithiasis and pancreatobiliary malignancies increases with advancing age, resulting in the older population requiring more invasive procedures. Although several studies on the safety of ERCPs in the elderly have been published, further investigation regarding the association between advanced age and difficult cannulation is required.

Research objectives

The purpose of this study was to investigate the association between the advanced age and difficult cannulation and the efficacy of different cannulation techniques. We also aimed to evaluate the impact of difficult cannulation on the occurrence of ERCP-related adverse events.

Research methods

Patients who underwent ERCP during the study period were prospectively studied and divided into two groups based on their age. The primary outcome measurements were cannulation difficulty, cannulation success rate, and ERCP procedure time in both groups. Causes of difficult cannulation, cannulation techniques used, and related adverse events were analyzed.

Research results

A total of 614 patients who underwent ERCP with a native papilla were included, of whom 146 were aged 80 years or older. The incidence of difficult cannulation and cannulation success rate in elderly patients were comparable to those in younger patients, and secondary cannulation techniques can be safely and efficaciously utilized in this group. In multivariate analyses with adjustment for potential confounders, age greater than 80 years was not associated with an increase in adverse events. However, patients with difficult cannulation and those with a Charlson Comorbidity Index ≥ 2 were more likely to develop adverse events.

Research conclusions

The prevalence of difficult biliary cannulation during ERCP is not more common in patients over 80 years of age. Using different cannulation techniques is effective in achieving biliary access in the elderly with a lower rate of post-ERCP pancreatitis compared with younger patients.

Research perspectives

This study was performed at a single center with a limited number of elderly patients. Multi-center prospective studies with a large sample of elderly patients are required to evaluate the short-and long-term consequences of difficult cannulation and advanced cannulation techniques.