Desenlaces clínicos de la colangiopancreatografía retrograda endoscópica en el paciente anciano, experiencia en un centro de referencia

Abstract

ERCP is a therapeutic endoscopic procedure to resolve obstructive pancreatobiliary diseases. They are procedures with a complication rate of less than 10%. There is controversy in the literature regarding the effects of this intervention in the geriatric population over 70 years of age, in terms of effectiveness and complications (specific to the procedure and derived from anesthesia). Objective: To determine the differences in endoscopic effectiveness (effective cannulation rate) and safety (complications of the procedure and intraoperative anesthesia), between populations older and younger than 70 years who underwent ERCP, in the years 2018 to 2020, in a reference institution. Methodology: A cross-sectional study was carried out, evaluating the mentioned outcomes in patients older and younger than 70 years. An exploratory analysis was also carried out in the eight-year-old population. Results: It was found that the effective cannulation rate was greater than 90%, without significant differences between all the groups explored. With respect to endoscopic complications, the distribution was homogeneous, with a higher, although not significant, rate of pancreatitis in those under 70 years of age. Among the complications related to anesthesia, those over 70 years of age had a higher rate of hypotension (9.6% vs 3.0%, p <0.05) and a higher requirement for intraoperative vasopressor support (10.6% vs 3 , 9%, p <0.05), but not a higher ICU requirement (7.6% vs 4.5%, p = 0.2). In octagenarians, the rate of anesthetic complications was similar (hypotension during procedure: 10.5% vs 4.75, p <0.05; intraoperative vasopressor support: 13.4% vs 5.0%, p <0.05) However, in this group there was a greater requirement for postoperative ICU (11.8% vs 3.8%, p <0.05), compared with those under 80 years of age. Conclusion: The present study suggests that there are no differences in the effective bile duct cannulation rate and it does not seem to be a variable that is altered by age, since it is possibly more affected by technical factors specific to the procedure. However, there are important differences between the groups examined in terms of the burden of comorbidities and complications derived from anesthesia, which seems to be related to age, especially in those older than 80 years. These findings invite prospective studies with an appropriate design to confirm these results.