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Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Nonagenarians: A Systematic Review and Meta-Analysis

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Abstract

Background

Recent advances in modern medicine have translated into increase in life expectancy in the USA and with that, a rise in the demand for invasive procedures in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice for managing various benign and malignant pancreatobiliary conditions and can be associated with various adverse events.

Aim

We performed a systematic review and meta-analysis to evaluate outcomes of ERCP in nonagenarians.

Methods

A comprehensive literature search was performed in Embase, MEDLINE, Web of Science, and Cochrane Review library until July 2020. Our primary outcomes were the rate of technical success and adverse events in nonagenarians. Secondary outcomes were comparison of technical success and adverse events compared with younger patients.

Results

The initial search revealed 4933 studies, of which 24 studies with 5521 patients met our inclusion criteria. Pooled technical success rate of ERCP in nonagenarians was 92%, and pooled adverse event rate was 7.8%. There was no significant difference in technical success rate and overall rate of adverse events comparing ERCP outcomes in nonagenarians with a relatively younger population. The risk of post-ERCP bleeding was significantly higher in nonagenarians compared to younger patients with OR = 1.986 [1.113–3.544], I2 = 0. ERCP-related mortality was also significantly higher in nonagenarians compared to younger patients with OR = 4.720 [1.368–16.289], I2 = 0.

Conclusion

There was no significant difference in technical success rate and risk of adverse events related to ERCP in nonagenarians compared to younger patients. However, the risk of bleeding and procedure-related mortality was significantly higher.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

OR:

Odds ratio

U.I:

Umair Iqbal

S.W:

Simcha Weissman

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

WPR:

Weighted pooled rates

CI:

Confidence intervals

N :

Total sample size

CLS:

Choledocholithiasis

CAD:

Coronary artery disease

CHF:

Congestive heart failure

DM:

Diabetes mellitus

HTN:

Hypertension

IHD:

Ischemic heart disease

CKD:

Chronic kidney disease

NR:

Not reported in the study

RCS:

Retrospective cohort study

COPD:

Chronic obstructive pulmonary disease

CVA:

Cerebrovascular accident

Afib:

Atrial Fibrillation

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, 17822, USA

    Umair Iqbal, Bradley D. Confer & Harshit S. Khara

  2. Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, 08638, USA

    Hafsa Anwar

  3. Division of Gastroenterology and Hepatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Muhammad Ali Khan

  4. Department of Internal Medicine, Hackensack Meridian Health, Palisades Medical Center, North Bergen, NJ, USA

    Simcha Weissman

  5. Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, USA

    Shivangi T. Kothari & Truptesh H. Kothari

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  1. Umair Iqbal
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Correspondence to Umair Iqbal.

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Iqbal, U., Anwar, H., Khan, M.A. et al. Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Nonagenarians: A Systematic Review and Meta-Analysis. Dig Dis Sci 67, 1352–1361 (2022). https://doi.org/10.1007/s10620-021-06950-2

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