Galeazzi Marianna, Mazzola Paolo, Valcarcel Breanna, Bellelli Giuseppe, Dinelli Marco, Pasinetti Giulio Maria, Annoni Giorgio
University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy.
NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.
BMC Gastroenterol. 2018 Mar 14;18(1):38. doi: 10.1186/s12876-018-0764-4.
The incidence of biliary tract pathology is growing with an age-related trend, and progresses as the population ages. Endoscopic Retrograde Cholangiopancreatography (ERCP) represents the gold standard for treatment in these cases, but evidence about its safety in the elderly is still debated.
We retrospectively analyzed the clinical records of all patients aged ≥65 undergoing ERCP between July 2013 and July 2015. Of 387 ERCP cases, 363 (~ 94%) were completed entirely. The mean age of the study population (n = 363) was 79.9 years old (range 70-95), with 190 subjects aged 70-79 and 173 older than 80. We recorded demographics, Charlson Comorbidity index (CCI), American Society of Anesthesiologists (ASA) physical status classification score, indication for the use of the ERCP procedure, and clinical outcomes. Then, we tested all variables to identify the potential risk factors for complications associated with the procedure.
The older group (those ≥80 years old) showed significantly more patients with ASA Classes III-IV than the younger one (those ≤79 years old). Interestingly, the CCI was higher in the younger group (p = 0.009). The overall complication rate was 17.3% without inter-group differences. Older age, sex, CCI and intra-ERCP procedures were not related to a higher risk of complications, and the multivariate regression did not identify any of the considered variables to be an independent risk factor for complications.
ERCP appears as safe in the patients aged 80 years and older, as it is in those aged 70-79 years old in our study, however, a selection bias may affect these findings. A study including a comprehensive geriatric assessment will contribute to shedding light on this issue.
胆道疾病的发病率呈与年龄相关的增长趋势，并随着人口老龄化而增加。内镜逆行胰胆管造影术（ERCP）是这些病例治疗的金标准，但关于其在老年人中的安全性证据仍存在争议。
我们回顾性分析了2013年7月至2015年7月期间所有年龄≥65岁接受ERCP治疗的患者的临床记录。在387例ERCP病例中，363例（约94%）全部完成。研究人群（n = 363）的平均年龄为79.9岁（范围70 - 95岁），其中190例年龄在70 - 79岁，173例年龄超过80岁。我们记录了人口统计学数据、Charlson合并症指数（CCI）、美国麻醉医师协会（ASA）身体状况分类评分、ERCP手术的使用指征以及临床结果。然后，我们对所有变量进行测试，以确定与该手术相关并发症的潜在危险因素。
老年组（年龄≥80岁）中ASA III - IV级的患者明显多于年轻组（年龄≤79岁）。有趣的是，年轻组的CCI更高（p = 0.009）。总体并发症发生率为17.3%，组间无差异。年龄、性别、CCI和ERCP术中操作与较高的并发症风险无关，多因素回归未发现任何所考虑的变量是并发症的独立危险因素。
在我们的研究中，ERCP在80岁及以上患者中似乎与70 - 79岁患者一样安全，然而，选择偏倚可能影响这些结果。一项纳入全面老年评估的研究将有助于阐明这一问题。
