Endoscopic retrograde cholangiopancreatography for patients aged ninety and older with choledocholithiasis: A single-center experience in south China

Background: Endoscopic retrograde cholangiopancreatography (ERCP) serves an essential role in treating biliary diseases, especially in choledocholithiasis. However, due to the limited human lifespan, there remains a paucity of clinical investigations on ERCP treatment in patients over 90 years old.

Aim: To explore the effectiveness and safety of ERCP in super-older patients aged ≥ 90 years with choledochal stones.

Methods: This study retrospectively analyzed data from patients (aged ≥ 65 years) with choledocholithiasis who received ERCP treatment in our hospital from 2011 to 2023. Among them, patients ≥ 90 years old were in the super-older group, and patients aged 65-89 years were in the older group. Baseline data, including gender, number of stones, stone size, gallbladder stones, periampullary diverticulum, and common bile duct intubation of patients in the two groups, were matched by adopting the 1:1 propensity score matching method.

Results: After matching, 44 patients were included in both the super-older group and the older group. The incidence of stroke in the super-older group was markedly higher than that in the older group [34.1% (15/44) vs 6.8% (3/44), P = 0.008]. The success rate of the ERCP procedure in the super-older group was 90.9% (40/44), compared to that in the older group [93.2% (41/44), P = 1.000]. Although endoscopic papillary balloon dilation was more frequently used in the super-older group than in the older group [61.4% (27/44) vs 18.2% (8/44), P < 0.001], there was no significant difference in terms of stone removal rate, the incidence of complications, mortality, recurrence, and length of hospitalization between the two groups (P > 0.05).

Conclusion: ERCP is safe and effective in super-older patients ≥ 90 years old with choledocholithiasis.