According to the WHO, by 2050 the global population aged 60 years & older is projected to double, reaching ~2.1 billion people. This demographic shift is expected to increase the demand for invasive medical procedures among older adults. Endoscopic retrograde cholangiopancreatography (ERCP) remains a cornerstone intervention in the management of pancreaticobiliary disorders & age-associated outcome data is scarce. We aimed to identify determinants of ERCP technical success & adverse events among patients <60 & ≥60 years, as per WHO definition of older adults.

Data from consecutive patients’ (>18 years) index ERCP at Saint Michael's Hospital, a large tertiary centre in Toronto, Canada from 2010-2020 were retrospectively analysed. The primary outcome was ERCP’s technical success & the secondary outcome was the occurrence of adverse events (post-ERCP pancreatitis, bleeding, perforation, or abdominal pain). Patients were stratified by age into 2 subgroups: <60 years & ≥60 years. To facilitate interpretation, a continuous age term scaled per 10-year increase was created. To identify independent predictors, univariable & multivariable logistic regression were constructed for the primary outcome. Firth penalized logistic regression was applied for adverse events due to their rarity. ORs & 95% CIs were reported.

Among patients aged ≥60 years, altered anatomy (OR 0.17, 95% CI 0.11-0.25), use of non-duodenoscope instruments (OR 0.42, 95% CI 0.22-0.83), history of cancer (OR 0.69, 95% CI 0.54-0.90), & liver-related conditions (OR 0.60, 95% CI 0.38-0.99) were independently associated with reduced odds of technical success. Among patients aged <60 years, altered anatomy (OR 0.16, 95% CI 0.07-0.36), use of non-duodenoscope instruments (OR 0.35, 95% CI 0.14-0.90), but also presence of pancreatic disease (OR 0.56, 95% CI 0.34-0.95) was associated with lower odds of success and female sex was associated with higher odds of success as compared to males (OR 1.52, 95% CI 1.10-2.09). Among patients aged <60, 5.8% experienced adverse events as compared to 6.1% among those aged ≥60. Increasing age (OR 1.26, 95% CI 1.04–1.54) & pancreatic ductal indication (OR 2.54, 95% CI 1.33–4.60) were associated with increased odds of adverse events in patients aged <60 years. Among those aged ≥60 years, general anaesthesia (OR 4.93, 95% CI 1.20–16.23) predicted higher adverse events.

These findings highlight that both patient-related comorbidities and procedure-related factors influence ERCP success and safety differently across age strata. Recognition of these may help guide procedural planning, patient counselling and operator allocation.