Assessing Pre-Procedural Outcomes and Technical Success In Elderly ERCP Patients Using The Charlson Co-Morbidity Index as a Marker of Frailty
GS Mellotte, J Maloney, A Aftab, F Janjua, F Zeb & G Courtney
Department of Gastroenterology and Hepatology, St Luke's Hospital Carlow and Kilkenny
There are more considerations when undertaking advanced endoscopic procedures in older patients. We assessed whether the Charlson CoMorbidity Index(CCI) could be used as a marker of frailty to help predict the outcome of ERCP in older patients.
To assess if age or CCI could be used as a measure to estimate ERCP technical success.
We retrospectively identified inpatient ERCPs performed in Kilkenny 2021-2022. Patients were grouped into older(65-79) and super old(>80). Primary endpoints were technical success and complications. Technical success was defined as diagnostic or therapeutic success relative to ERCP indication. The CCI was calculated for all patients.
81 ERCP procedures were identified, mean age 77(range65-93). Mean CCI 4.36(Range 2-12). 9(11.1%) procedures were not able to approach cannulation due to anatomy. Minor complications in 4(4.9%) procedures, 1 episode of mild pancreatitis. There was no mortality as a result of complications. 66 of 72(91.6%) of ERCPs were technically successful. Comparison of the super old with the older group did not show significant difference in technical success or complications(P=0.119, p=0.9). ERCPs limited by anatomy were significantly associated with the older group(p=0.004) Logistic regression was performed to ascertain the effects of age, and CCI on the likelihood that ERCP was technically successful or complications. The model did not reach statistical significance (p=0.453 & 0.897).
ERCP outcomes were similar in older and super old patients. Older patients had significantly higher rates of technical factors limiting ERCP. CCI as a surrogate marker of frailty was not accurate in predicting preprocedural technical success or complications.