Biliary septic shock in elderly patients: is ERCP indicated?

Aims Biliary septic shock (BSS) causes significant mortality. It is not clear whether its beneficial to perform emergent ERCP, specially in older patients.

Objective To determine clinical benefit of ERCP in patients with BSS.

Methods Retrospective multicentric analysis of a prospective database of ERCP complications/mortality indicated for infections: Acute CholanGitis (ACG), Acute CholeCystitis (ACC) and BSS (October 2014 – May 2024). We analyse complications (ASGE 2010)/mortality at 24 hours, 7 and 30 days, and its relationship with ERCP.

Results Four-hundred thirty (42.8% women; age: 77,3±12,9) out of 2183 ERCP were indicated for biliary infections: 284(66%) ACG, 77(18%) ACC and 69(16%) BSS. In the first 30 days there were 51 (11.8%) complications: 27(6,3%) mild, 23(5,3%) moderate, 1(0,2%) severe and 13(3%) death; 47 were related to ERCP and 17 no. When analysing the relationship with ERCP, non-related complications were more frequent in BSS (10.8% vs 2.8%), while ERCP -related complications were more frequent in ACG+ACC (11.9% vs 5.8%) (p=0.007). Most of the deaths happened in BSS (5 out of 64 cases: 7.2%) and were not related to ERCP, in comparison to CGA/CCA (8 of 353 cases: 2.2%), in which death was related to ERCP p=0.042. When analysing by age, the majority of BSS happened in older than 80 years (p=0.009), with higher mortality in this age group (p=0.000), but it was related to baseline conditions more than ERCP.

Conclusions ERCP is indicated in patients with BSS because it is not associated with higher complications or mortality technique-related in comparison to ACG and/or ACC, even in elderly patients.

Publication History

Article published online:
27 March 2025