Keywords: Endoscopic retrograde cholangiopancreatography (ERCP), Procedure-related complications, Geriatric population

Aim:

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive and technically demanding procedure with potential complications. We aimed to evaluate procedural outcomes, predictors of difficult cannulation, and safety, particularly in elderly patients, based on our one-year single-center experience.

Method:

This retrospective study included patients who underwent ERCP between October 1, 2024, and October 1, 2025. Demographic characteristics, procedural details, indications, and outcomes were obtained from hospital records. Ethical approval was granted by the institutional ethics committee. Statistical analyses were performed using SPSS software.

Results:

A total of 120 patients were included, 60% (n=72) female, with a mean age of 68 years (range: 23–96). The overall cannulation success rate was 91%. Failed cannulation (9%) was mainly related to malignant biliary obstruction, periampullary diverticula, or altered anatomy. Seventy percent of patients had a naïve papilla, while 30% had previous sphincterotomy. Primary indications were biliary pancreatitis (n=34), cholangitis (n=33), malignancy (n=21), stent removal (n=19), and asymptomatic choledocholithiasis (n=10). Periampullary diverticula were present in seven patients. Difficult cannulation occurred in nine cases, mainly due to protruding papillary morphology, and was successfully managed predominantly with the double-wire technique. Common bile duct stones were identified in 58% of patients, with a 92% extraction success rate. Biliary stents were placed in 78% and pancreatic stents in 3% of patients. No mortality occurred. The overall complication rate was 14%, with bleeding as the most common event, managed endoscopically with adrenaline injection with or without stent placement. Complication rates were not associated with age, gender, indication, diverticula, or difficult cannulation (p>0.05). Previous sphincterotomy was associated with fewer complications (p<0.05). In patients aged >65 years, neither complication nor difficult cannulation rates were increased.

Conclusions:

ERCP can be performed safely and effectively in experienced hands, including in elderly patients. Advanced age alone should not be considered a risk factor for procedural difficulty or complications.