Supplementary Material for: Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients (≥80 Years) with Choledocholithiasis: A Comprehensive Meta-Analysis

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for choledocholithiasis. However, elderly patients, particularly those aged ≥80 and ≥90, may face higher risks of complications due to comorbidities and age-related anatomical changes. This meta-analysis aimed to evaluate efficacy and safety of ERCP in this population.
Methods: A systematic search yielded 17 retrospective studies. Data were synthesized using both single-arm and comparative analyses, with subgroup analyses focusing on nonagenarians (≥90 years). Outcomes assessed included complete stone clearance, cannulation success, adverse events (AEs), sedation strategies, and biliary stent use.
Results: The pooled stone clearance rate was 77% in patients ≥80 and 65% in nonagenarians. When multiple ERCP sessions were employed, clearance rates increased to 84% in patients aged ≥80 and 82% in nonagenarians, compared with 61% and 38%, respectively, for single-session procedures. The pooled AEs rate was 8% in patients ≥80 and 6% in those ≥90, with ERCP-related mortality between 0% and 1%. Complete clearance was significantly lower in patients aged ≥80 versus those aged <80 (OR = 0.41; P = 0.003), and in patients aged ≥90 versus those aged <90 (OR = 0.30; P = 0.047), while cannulation success and AEs was similar. Additionally, elderly patients were more likely to receive general anesthesia (OR = 7.08, P < 0.001) and biliary stenting (OR = 2.78; P = 0.002), with permanent stents used more frequently (OR = 15.66, P < 0.001). Nonagenarians experienced higher cardiopulmonary risks (OR = 4.60; P = 0.042).
Discussion: ERCP is effective and safe for elderly patients, though age-related challenges necessitate tailored approaches. Staged procedures and age-adjusted sedation can mitigate risks. While permanent stenting offers palliative utility, long-term monitoring is essential to address late complications.