Risk Factors Of Complications In Therapeutic ERCP For Patients Aged ≥85 Years

BackgroundEndoscopic retrograde cholangiopancreatography is a minimally invasive treatment for the diagnosis and treatment method of biliopancreatic disease,it is a technology to diagnose and treat disease with duodenoscope by X-ray.Its major indications include choledocholithiasis,cholangiopancreatic tumor,unexplained jaundice,etc.With the rapid development of radiography,especially the application of magnetic resonance cholangiopancreatography,ERCP gradually becomes a simple treatment which is no longer a diagnostic tool.Compared with surgical operation,ERCP has the advantages of low trauma,quick recovery and high repeatability,so it is accepted by patients more easily,especially for elderly patients.However,its complications can’t be ignored.Complications of ERCP usually include post-ERCP pancreatitis,hemorrhage,perforation,cholangitis,etc.Serious complications can lead to disastrous consequences or even death,especially for elderly patients.For their poor health condition and a lot of underlying diseases,they have adverse consequences more easily.In recent years,there are also some studies on complications of ERCP in elderly patients,but the age setting is generally 60,70 or80 years old,there are still few studies on patients over 85 years old.This study adopted retrospective analysis to study the risk factors of therapeutic ERCP complications in patients over 85 years old.ObjectiveThe clinical data of patients aged≥85 years treated with therapeutic ERCP in the department of gastroenterology of our hospital were retrospectively analyzed to study the risk factors of complications and provide a reference for clinicians.Method132 cases of therapeutic ERCP patients aged≥85 years who were admitted to our hospital from September 2011 to September 2017 were collected and divided into two groups according to whether there had complications or not.Clinical data of the two groups were collected and compared statistically.Case datas include general and clinical data of patients,general data included age,sex,surgical indications,comorbidity,use of antithrombotic drugs,duodenal diverticulum,and previous ERCP history;clinical data included surgical method,intubation time and postoperative complications.SPSS21.0 was used for statistical analysis of the data,counting data is expressed as a percentage(%),comparison between groups was conducted byχ~2 test,continuous correctedχ~2 test or Fisher exact probability test;the measurement data of non-normal distribution are expressed by the median(lower quartile,upper quartile),Wilcoxon rank sum test was used for comparison between groups.For multivariate analysis,univariate regression analysis was performed on variables that might be related to the occurrence of complications,variables with P<0.05 enter the multivariate regression model,Logistic stepwise regression analysis was performed.P<0.05 was considered statistically significant,and independent risk factors for complications in patients aged 85 were obtained.Result1.A total of 26 patients had complications,among which bleeding was the most frequent,with a total of 7 cases.The other complications were cholangitis(4 cases),pancreatitis(3 cases),heart failure(2 cases),perforation(2 cases),pneumonia(2 cases),hypoxemia(2 cases),atrial fibrillation(2 cases),intestinal obstruction(1 cases)and heart failure with pneumonia(1 cases)in order of frequency.2.Analysising the possible single factors that can cause complications of the patients who are aged≥85 years old,increasing age(P=0.001),bile duct carcinoma(P=0.017),the antithrombotic drug intake(P=0.007),the intubation time(P=0.001)was statistically significant,and these factors were substituted into the Logistic multifactor regression analysis,found that increasing age(OR=1.278,P=0.002,95%CI:1.092~1.496)and prolonged intubation(OR=1.104,P=0.006,95%CI:1.026~1.184)were independent risk factors for complications in patients aged≥85years.3.The highest frequency of complications of bleeding events were further analyzed to the univariate analyses,found that age(P=0.008)and the antithrombotic drug intake(P=0.038)was statistically significant,and then take these factors into Logistic analysis,found that only the antithrombotic drug intake(OR=6.242,P=0.022,95%CI:1.304~29.889)was independent risk factors for the bleeding.ConclusionAge increasing and prolonged intubation were independent risk factors fortherapeutic ERCP complications in patients aged≥85 years;the antithrombotic drug intake was independent risk factors for therapeutic ERCP bleeding in patients aged≥85 years.