Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-20283 | DOI: 10.14744/tjtes.2025.20283

Is Endoscopic Retrograde Cholangiopancreatography a Reliable Procedure in Advanced Ages? Single Tertiary Center Experience

Yasin Kara¹, Ali Kocataþ¹, Osman Köneþ², Erkan Somuncu¹, Ýlhan Gök¹, Gulseren Yilmaz³, Ümmihan Topal⁴, Mustafa Uygar Kalaycý^5
1University of Health Sciences, Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
²Medicana Zincirlikuyu Hospital, Department of General Surgery, Istanbul, Turkey.
³University of Health Sciences, Department of Anesthesiology and Reanimation, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
⁴University of Health Sciences, Department of Radiology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
⁵Atlas University, Department of General Surgery, Istanbul, Turkey

ABSTRACT
BACKGROUND: This study aimed to determine the reliability and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients compared to that in younger group.
METHODS: In this retrospective study, ERCP procedures at our endoscopy unit performed between December 2020 and October 2024 were reviewed. Elderly patients aged ≥80 years (AA group) and younger patients aged <65 years (control group) were included and thier demographics, comorbidities, American Society of Anesthesiologists (ASA) scores, ERCP indications, procedural success, and complications were compared.
RESULTS: There was a significant difference in ASA scores, comorbidities, and usage of anticoagulant or antiplatelet drugs between the groups (p<0.05, p<0.01, and p<0.05, respectively). Juxtapapillary diverticula was more common in the AA group than in the control group (21% vs 5.1%, p<0.01). In terms of indications, choledocholithiazis and obstructive jaundice were the most common in both groups (p=0.456 and p=0.064, respectively). The rate of cannulation success was not significantly different between the groups (p=0.956). Sphincterotomy and stone extraction with balloon and basket were prevalent interventions in both groups (p=0.22 and p=0.563, respectively). Postprocedural pancreatitis was statistically significantly higher in the control group than in the AA group (p=0.041). There was no significant difference in other complications such as bleeding, perforation, infection, basket impaction, and cardiopulmonary complications between the groups (p=0.436, p=0.354, p=0.958, p=0.254, and p=0.289, respectively).
CONCLUSIONS: Therapeutic ERCP procedures can be applied safely and efficiently to elderly patients as thier outcomes are comparable to those observed in younger patients

Keywords: Advanced age, safety, endoscopic retrograde cholangiopankreatography, complications, indications.

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Endoskopik Retrograd Kolanjiyopankreatografi Ýleri Yaþlarda Güvenilir Bir Ýþlem midir? Üçüncü Basamak Tek Merkez Deneyimi

Yasin Kara¹, Ali Kocataþ¹, Osman Köneþ², Erkan Somuncu¹, Ýlhan Gök¹, Gulseren Yilmaz³, Ümmihan Topal⁴, Mustafa Uygar Kalaycý^5
1Saðlýk Bilimleri Üniversitesi, Genel Cerrahi Kliniði, Kanuni Sultan Süleyman Eðitim ve Araþtýrma Hastanesi, Ýstanbul, Türkiye
²Medicana Zincirlikuyu Hastanesi, Genel Cerrahi Bölümü, Ýstanbul, Türkiye
³Saðlýk Bilimleri Üniversitesi, Anestezi ve Reanimasyon Kliniði, Kanuni Sultan Süleyman Eðitim ve Araþtýrma Hastanesi, Ýstanbul, Türkiye
⁴Saðlýk Bilimleri Üniversitesi, Radyoloji Kliniði, Kanuni Sultan Süleyman Eðitim ve Araþtýrma Hastanesi, Ýstanbul, Türkiye
⁵Atlas Üniversitesi, Genel Cerrahi Kliniði, Ýstanbul, Türkiye

AMAÇ: Bu çalýþmanýn amacý ileri yaþlý hastalarda endoskopik retrograd kolanjiyopankreatografinin (ERCP) güvenilirliðini, daha genç kontrol grubuyla karþýlaþtýrarak belirlemektir.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþmada, Aralýk 2020 ile Ekim 2024 tarihleri arasýnda endoskopi ünitemizde gerçekleþtirilen ERCP prosedürleri incelenerek, ileri yaþ hastalar (≥80 yaþ) (Grup AA) ve daha genç hastalar (<65 yaþ) (Kontrol grubu) dahil edilerek demografik özellikler, eþlik eden hastalýklar, Amerikan Anestezistler Derneði (ASA) skorlarý, ERCP endikasyonlarý, iþlem baþarýsý ve komplikasyonlar açýsýndan birbirleriyle karþýlaþtýrýldý.
BULGULAR: Ýki grup arasýnda ASA skorlarý, komorbiditeler ve antikoagülan ve antiplatelet ilaç kullanýmý açýsýndan anlamlý fark vardý (p<0,05, p<0,01 ve p<0,05). Juxtapapiller divertikül grup AA'da kontrol grubuna göre daha yaygýndý (%21'e karþý 5,1, p<0,01). Endikasyonlar açýsýndan her iki grupta da en sýk koledokolithiazis ve obstrüktif sarýlýk görüldü (p=0,456, p=0,064). Kanülasyon baþarýsý açýsýndan iki grup arasýnda anlamlý fark yoktu (p=0,956). Her iki grupta da en çok yapýlan giriþimler sfinkterotomi ve balon ve basket ile taþ ekstraksiyonu idi (sýrasýyla p=0,22 ve p=0,563). Ýþlem sonrasý pankreatit oraný genç grupta istatistiksel anlamlý olarak daha yüksekti (p=0,041). Kanama, perforasyon, enfeksiyon, basket sýkýþmasý ve kardiyopulmoner komplikasyon oranlarý açýsýndan iki grup arasýnda anlamlý fark saptanmadý (p=0,436; p=0,354; p=0,958; p=0,254; p=0,289).
SONUÇ: Terapötik ERCP iþlemleri ileri yaþ hastalarda da uygun endikasyonlarla, genç yaþ grubu ile karþýlaþtýrýlabilir komplikasyon ve sonuçlarla güvenli ve etkin bir þekilde uygulanabilir.

Anahtar Kelimeler: Ýleri yaþ, güvenlik, endoskopik retrograd kolanjiyopankreatografi, komplikasyonlar, endikasyonlar.

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