Endoscopic retrogade cholangiopancreatography is safe and effective method for diagnosis and treatment of biliary and pancreatic disorders in octogenarians

Background and aim : Diagnosis and treatment of pancreatic and biliary diseases represents a special problem in old patients who often suffer from one or more concomitant diseases. The aim of this study was to evaluate the safety and efficacy of ERCP in very old patients (octogenarians). Patients and methods : Patients 80 years or older who under- went ERCP from October 2001 to December 2005 were studied retrospectively. Results : A total of 209 patients (121 women, 88 men), with a mean age 86 ± 4.4 years old (80-102) underwent 251 ERCPs. All but three patients tolerated the procedure well. Three procedures were not completed due to patients' discomfort (1.4%). Two of these patients underwent percutaneous transhepatic cholangiog- raphy and the other one was treated conservatively. A cholan- giogram was obtained in 193 cases (92.3%), although in 7 patients an additional attempt was required. The main endoscopic findings were common bile duct stones in 51.8% (100/193) and cancer in 28% (54/193) of patients. Based on the diagnostic findings, a ther- apeutic intervention was indicated in 189 patients (90.4%) and was achieved in 181 of them (95.8%). Complications were observed in 9.6% of ERCPs (24/251). Post - ERCP mild pancre- atitis was the more frequent complication in 11 procedures (4.4%). No severe pancreatitis was observed. Six procedures were compli- cated by cholangitis (2.4%) and two by cholecystitis (0.8%). Early surgical intervention was required in 2 cases because of oesophageal perforation and retroperitoneal perforation respec- tively. Two patients died (0.8%) ; one patient with pancreatic can- cer died due to septic shock after inadequate biliary drainage and the other one died after operation for retroperitoneal perforation. Conclusions : In conclusion, ERCP is safe and effective method for diagnosis and treatment of biliary and pancreatic disorders in octogenarians despite the high comorbidity in this group of patients. (Acta gastroenterol. belg., 2007, 70, 199-202).