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PTU-42 Safety and efficacy of ERCP for removal of CBD stones in the nonagenarians: Retrospective study
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  1. Amaan Khan,
  2. Sijjad Ijaz Ijaz,
  3. Mohammed Gariballa,
  4. Mustafa Jalal,
  5. Yasser El-Sherif,
  6. Amer Al-Joudeh
  1. Sheffield Teaching Hospitals, Sheffield, UK

Abstract

Introduction It is estimated that one in four persons in the UK will be >65 years old by 2050. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended therapy for removals of common bile duct (CBD) stones. There is a lack of UK data on the outcome of ERCP in the very elderly. We aimed to investigate the safety and efficacy of ERCP in the management of CBD stones in the elderly >90 years old compared with those aged 65-89 years old.

Methods We retrospectively analysed patients undergone ERCP between 2016-2020. Those with conditions other than suspected CBD stones were excluded. The following data was collected: general demographics, comorbidities, American Association of Anaesthesiology (ASA) grading, presence of dementia, anticoagulation therapy, endoscopic report on completed intention of treatment which is defined by either removal of stone and/or stent insertion. Also, post-procedure complications were collected including post-ERCP pancreatitis (PEP), bleeding, perforation, cholangitis, respiratory, and cardiovascular (CVS) events. Readmission within 7 days and death within 30 days were collected. Outcomes were reported as mean ± (SD) or n (%). Statistical significance was considered when P <0.05

Results In total, 126 patients ≥ 90 years (group A) compared to 262 patients aged 65-89 years (group B). Group A had higher ASA grading 3 ± (0.6) compared to group B 2 ± (0.6), p 0.03. The total number of comorbidities was not different between the two groups, p 0.5. Group A had significantly higher rate of dementia, and anticoagulation therapy 22 (17.4%) vs 1 (0.4%) p <0.0001 and 46 (36.5%) vs 47(17.9%) p <0.0001, respectively. Completed intention of treatment was achieved in group A in 114 (90.5%) compared to group B 233 (89.9%), p 0.7. PEP occurred in 1 patient (0.8%) in group A compared to 8 (3.1%) in group B, p 0.3. Respiratory complications were significantly higher in group A compared to group B, 7 (5.6%) vs 1(0.4%), p 0.001. The overall complications rate was 17 (13.5%) in group A vs 25 (9.5%) in group B, p 0.3. None of group A were readmitted within 7 days, 0% vs 4 (5.3%), p 0.008. Four cases (3.2%) died within 30 days in group A compared to group B 5 (1.9%), p 0.5. Three deaths in groups A were caused by pneumonia including two deaths with COVID-19 pneumonia. There was no procedure-related death

Conclusions ERCP for removal of CBD stones in >90 years old is effective. Risk of post-ERCP pancreatitis and overall adverse events were not higher in the > 90 years compared to 65-89 years old. We report a 30-day mortality rate of 3.2%. The most common cause of death was pneumonia including COVID-19 peumonia.

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