Zhou Yang, Li Yuanyuan, Zhu Aijing, Huang Shuaijing, Liang Yan, Yue Chunxiao, Bai Xiaoyu, Feng Yadong
Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China.
Eur Geriatr Med. 2025 Sep 2. doi: 10.1007/s41999-025-01296-8.
Current opinions on endoscopic retrograde cholangiopancreatography (ERCP) safety in older patients are contentious. This study aimed to assess emergency one-stage endoscopic treatment for choledocholithiasis-related cholangitis in older adults.
Patients with choledocholithiasis related cholangitis from January 2019 to July 2023 were recruited. A propensity score (PS) framework was then used to evaluate clinical outcomes after ERCP in patients over 80 years of age.
Inclusion criteria yielded 374 patients, with 120 pairs matched via PS (median age: 85.1 years; 49.2% male in the older group). There was no significant difference in in-hospital mortality between the older adult ERCP group and the control group (2.5% vs. 0%, P = 0.081), whereas intensive care unit (ICU) admissions were higher (38.3% vs. 17.5%, P < 0.001) and length of hospital stay (LOHS) were longer (10 days vs. 8.5 days, P < 0.001). Multivariate analysis revealed that factors affecting LOHS included procalcitonin (PCT), creatinine (Cr), age, and adverse events related to post-ERCP. The independent factor rising ICU admission was age. Subgroup analysis revealed early ERCP reduced antibiotic use and hospitalization in older patients. Severe acute cholangitis (SAC) increased antibiotic use duration and 30-day mortality, while comorbidities raised ICU admission rates, ICU duration, and antibiotic use.
One-stage endoscopic treatment is safe and effective for older patients, with higher age linked to increased ICU admissions. Early ERCP benefits hospital outcomes, feasible even in severe SAC or comorbid conditions.
目前关于老年患者内镜逆行胰胆管造影术（ERCP）安全性的观点存在争议。本研究旨在评估老年胆总管结石相关性胆管炎的急诊一期内镜治疗。
招募2019年1月至2023年7月患有胆总管结石相关性胆管炎的患者。然后使用倾向评分（PS）框架评估80岁以上患者ERCP后的临床结局。
纳入标准产生了374例患者，通过PS匹配了120对（年龄中位数：85.1岁；老年组男性占49.2%）。老年ERCP组与对照组的住院死亡率无显著差异（2.5%对0%，P = 0.081），而重症监护病房（ICU）入院率更高（38.3%对17.5%，P < 0.001），住院时间（LOHS）更长（10天对8.5天，P < 0.001）。多变量分析显示，影响LOHS的因素包括降钙素原（PCT）、肌酐（Cr）、年龄以及与ERCP后相关的不良事件。导致ICU入院增加的独立因素是年龄。亚组分析显示，早期ERCP减少了老年患者的抗生素使用和住院时间。严重急性胆管炎（SAC）增加了抗生素使用时间和30天死亡率，而合并症提高了ICU入院率、ICU住院时间和抗生素使用。
一期内镜治疗对老年患者安全有效，年龄越大，ICU入院率越高。早期ERCP有利于改善住院结局，即使在严重SAC或合并症情况下也可行。
