Endoscopic Retrograde Cholangiopancreatography in the Elderly

Background: Biliary tract diseases in the elderly are common and representing particular both diagnostic and therapeutic problems. Endoscopic retrograde cholangiopancreatography (ERCP) is effective for the diagnosis and treatment of hepatobiliary and pancreatic diseases. Objective: To study the presentations of obstructive biliary disease, and the treatment outcome in elderly patients who undergoing ERCP. Methods: A retrospective analysis of the presenting symptoms, complete blood counts, liver function tests, abdominal ultrasounds, ERCP results, and outcomes were assessed in 140 patients, aged 75 years and older at Sawanpracharak Hospital, Nakhonsawan province. Results: ERCP was successful in 121 patients (86%); 68 had common bile duct (CBD) stones, 34 had malignant biliary obstruction, and 19 had other findings. In comparison the presenting symptoms of CBD stones and malignant biliary tract obstruction, we found that atypical symptoms (abdominal pain and non-specific symptoms) were presented more commonly in CBD stones (45% VS 12%, p <0.05), whereas painless jaundice was more common in malignant biliary tract obstruction (47% VS 21%, p <0.05). Charcot’s triad as a presentation was not different between both groups (18% VS 21%, p >0.05). Ultrasonography and ERCP findings were in agreement for only 45%. Endoscopic clearance of CBD stones was achieved in 52% and endoscopic palliation of malignant obstruction was successful in 59%. ERCP-related complications without mortality occurred in 3 patients. Conclusions: In elderly patients with CBD stones often presented with atypical symptoms. In malignant disease such as cholangiocarcinoma patients presented with painless jaundice. We found that ERCP is safe and effective for the management of biliary tract obstruction in both benign and malignant diseases.