Endoscopic retrograde cholangiopancreatography (ERCP) is utilised as a therapeutic tool to treat pancreatobiliary diseases.  Inherently, it carries a risk of complications ranging from mild to fatal.  With an ageing population, a significant proportion of patients requiring an ERCP are >80 years.  Complications in this age group are significantly higher.  The aim of this study was to evaluate the safety of ERCPs in individuals >80 years by calculating the incidence of complications and associated mortality rate at our centre.

A retrospective review of individuals >80 years old who underwent an ERCP at our centre.  Data was collected across 2 years and 10 months between January 2023 and October 2025.  Endoscopic database was scrutinised to obtain data regarding details of the procedure, including medications administered and immediate complications.  Electronic records were analysed to determine the indications, the presence of any intermediate/medium term complications as well as mortality.  Pathology database was reviewed to assess blood results at the time of the procedure.

A total of 398 ERCPs were performed during the 34-month time frame.  Of which, 110 (27.6%) procedures had been performed on individuals of at least 80 years of age.  Median age was 86 (IQ range 83-89).  56.4% of them were male.  Median dose of midazolam and fentanyl administered were 1.25mg (IQ range 1-1.25), 25mcg (IQ range 25-37.5), respectively.  43.1% of patients received hyoscine butylbromide.  

91.8% of patients received PR diclofenac. All patients received intravenous fluids pre and post procedure. Mean ALT, ALP and bilirubin prior to ERCP was 125 (IQ range 36.5-169), 592 (IQ range 174-705) and 115 (IQ range 14.5-155), respectively. 

The decision to perform an initial ERCP was determined by at least 2 of the 3 parameters: imaging, biochemistry or symptoms. 90.6% of patients fulfilled minimum 2 criteria. Most common indication for ERCP was choledocholithiasis +/- cholangitis (68%). Other indications were abnormal imaging indicative of hepato pancreato biliary cancer.

Complications were found in 10% of the cohort.  Most common complication was post-ERCP pancreatitis and post ERCP cholangitis, occurring in 4.5% and 3.6% of procedures respectively.  Delayed bleeding occurred in 0.1% of patients.  There were no patients in this study who sustained a perforation.  One patient in the cohort of 110 patients died from cardiorespiratory arrest and 1 patient died from post-ERCP pancreatitis resulting in a total mortality rate of 1.8% ( multiple co-morbidities and frailty).  In 5 of the 110 procedures, a repeat ERCP was required due to inability to cannulate.  An alternative procedure, such as an EUS or PTC was organised.

Outcomes of this study indicate that ERCP is safe in this age group for sepsis and decompressing of the biliary system, when two out of three pre-requisition criteria are met and safe sedation practices are followed.  When compared to national metrics there is no difference in complication rates in those over the age of 80.