Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older

Goals: To review our experience of endoscopic retrograde cholangiopancreatography (ERCP) in patients 90 years and older. Background: ERCP is effective in the investigation and treatment of biliary disease; however, in the very elderly, a perception of high procedural risk and lack of efficacy may limit its use. Study: Retrospective analysis of ERCPs performed on patients 90 years of age and older from one institution. Results: Between 1987-2000, 23 ERCPs were performed on patients 90 years of age and more (16 women; age range, 90-96 years). The primary indications were obstructive jaundice (16 patients), pancreatitis (2), cholangitis (1), unexplained abdominal pain (1), and planned follow-up (3). The main endoscopic findings were common bile duct (CBD) stone (15 patients), pancreatic carcinoma (2), cholangiocarcinorna (2), and dilated duct (only 1). Sixteen sphincterotomies were performed, with successful common duct clearance in 10 patients. Seven biliary stents were inserted for benign disease and three, for malignancy. In two patients, CBD carmulation was unsuccessful. Three minor hemorrhages were controlled endoscopically. Three patients died of nonprocedural causes. Conclusions: ERCP is safe and effective in the very elderly. The decision to undergo ERCP should be determined by clinical need.