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The protective effect of advanced age on post-ERCP pancreatitis and unplanned hospitalisation.
Intern Med J. 2015 Jun 30;
Authors: Maitin-Casalis N, Neeman T, Thomson A
Abstract
BACKGROUND: As the median age of Australia's population rises, endoscopic retrograde cholangiopancreatography (ERCP) is becoming increasingly used in the elderly. However, ERCP remains associated with serious complications including post-ERCP pancreatitis (PEP), which often necessitate unplanned hospital admission. Whilst previous research has demonstrated a protective effect of age against PEP, inconsistencies have arisen in recent studies. In addition to age, post-ERCP complication rates have been previously shown to be affected by various factors including longer procedure duration and high-risk indications.
AIMS: To investigate the rates of PEP and unplanned hospital admission or prolongation of hospital stay (UHAP) across age-groups and their relation to procedure duration and indication.
METHODS: Prospective analysis of 1284 consecutive ERCPs on patients aged 20-101 years performed at a tertiary referral centre RESULTS: Advanced age (>80 years) was associated with a significantly lower risk of both PEP (p=0.02) and UHAP (p< 0.05) compared to patients aged 50-79 years. Rates of PEP and UHAP differed significantly according to indication (p< 0.01) and longer procedure duration similarly increased the risk of both complications (p<0.01). However, there were no significant differences between age-groups in terms of the proportion of patients with 'high-risk' indications. Importantly, age remained a significant negative predictor of PEP even after adjusting for procedure duration (p = 0.04).
CONCLUSIONS: The protective effect of age against PEP and UHAP is not due to confounding by high-risk indications or increased procedure duration. ERCP may be a relatively safe option for our growing cohort of elderly patients.
PMID: 26122669 [PubMed - as supplied by publisher]