{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:02:05Z","timestamp":1779775325339,"version":"3.53.1"},"reference-count":106,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>As the global population ages, the demand for endoscopic retrograde cholangiopancreatography (ERCP) in the \u201coldest old\u201d (\u2265\u200985\u2009years) is steadily increasing. Despite their vulnerability, the existing evidence base for prophylaxis is heavily derived from younger populations, creating a significant extrapolation gap. Current guidelines for the prevention of Post\u2010ERCP pancreatitis (PEP) advocate for universal measures\u2014such as aggressive hydration and rectal nonsteroidal anti\u2010inflammatory drugs\u2014based on trials that frequently exclude frail patients with significant comorbidities. This perspective piece challenges the \u201cone\u2010size\u2010fits\u2010all\u201d application of these protocols in the geriatric demographic, proposing a hypothetical clinical practice approach. We conducted a targeted review of peer\u2010reviewed literature focusing on the pathophysiology of the aging pancreas and the safety of prophylactic interventions. Key findings reveal a \u201crisk\u2010outcome dissociation\u201d: while pancreatic senescence biologically lowers PEP incidence, frailty increases mortality when it occurs. Regarding fluid management, we propose a hypothesis\u2010driven, restrictive hydration rate of 1.7\u2009mL\/kg\/h without a bolus for patients with heart failure. This rate is physiologically grounded (adapted from the Holliday\u2010Segar pediatric maintenance formula for the altered body composition of the elderly) to provide \u201cenhanced maintenance\u201d to cover fasting deficits while avoiding the volume surge (\u2265\u20093\u2009mL\/kg\/h) that precipitates pulmonary edema in non\u2010compliant ventricles. Treating the elderly requires a paradigm shift to \u201cPrecision Geriatric Endoscopy\u201d, utilizing biomarker\u2010driven triage and bedside frailty tools. Most critically, this proposed protocol represents a pathophysiological hypothesis and framework rather than established evidence. Future prospective randomized controlled trials are urgently needed to validate this approach.<\/jats:p>","DOI":"10.1111\/ggi.70548","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T23:59:28Z","timestamp":1779321568000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post\u2010Endoscopic Retrograde Cholangiopancreatography Pancreatitis in the Oldest Old: Balancing Pancreatic Protection and Cardiorenal Safety: A Narrative Review"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8134-8524","authenticated-orcid":false,"given":"Koji","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"},{"name":"Department of General Medical Science Graduate School of Medicine, Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"},{"name":"Department of General Medical Science Graduate School of Medicine, Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terunao","family":"Iwanaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"},{"name":"Department of General Medical Science Graduate School of Medicine, Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Sakuma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"},{"name":"Department of General Medical Science Graduate School of Medicine, Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2238-9558","authenticated-orcid":false,"given":"Hidehiro","family":"Kamezaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"},{"name":"Department of General Medical Science Graduate School of Medicine, Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/6757524"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl13310"},{"issue":"2","key":"e_1_2_11_4_1","first-page":"193","article-title":"Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Patients Over 75\u2009Years of Age","volume":"19","author":"Wang S.","year":"2023","journal-title":"Journal of Minimally Invasive Surgery"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)62167-9"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1244208"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1075-4080"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2022.10.005"},{"issue":"5","key":"e_1_2_11_9_1","first-page":"465","article-title":"Post\u2010Operative Pancreatitis Following ERCP and EST in Elderly Patients With Choledocholithiasis","volume":"93","author":"Wang J.","year":"2025","journal-title":"Cirugia y Cirujanos"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2003.363"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2006.05.010"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-016-4064-y"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-021-06950-2"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(91)70740-2"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2001.117550"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01279.x"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2025.03.639"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.10.027"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58091261"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl250359"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000001103"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.14966"},{"issue":"1","key":"e_1_2_11_23_1","first-page":"109","article-title":"Post\u2010ERCP Acute Pancreatitis and Its Risk Factors","volume":"6","author":"Iorgulescu A.","year":"2013","journal-title":"Journal of Medical Life"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00380.x"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-024-08693-2"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050051"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000002549"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-018-0764-4"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1999.01121.x"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1377875"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.06.051"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.26.4.406"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0b013e328349e346"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1159\/000200762"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(02)70112-0"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1365281"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(03)02876-1"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/00129689-200608000-00002"},{"issue":"5","key":"e_1_2_11_39_1","first-page":"326","article-title":"Periampullary Diverticula: Consequences of Failed ERCP","volume":"80","author":"Lobo D. N.","year":"1998","journal-title":"Annals of the Royal College of Surgeons of England"},{"issue":"3","key":"e_1_2_11_40_1","first-page":"299","article-title":"Relationship Between Intraduodenal Peri\u2010Ampullary Diverticulum and Biliary Disease in 178 Patients Undergoing ERCP","volume":"6","author":"Wu S. D.","year":"2007","journal-title":"Hepatobiliary & Pancreatic Diseases International"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-995566"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-42614"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.06.045"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01537220"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800710402"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2014.11.005"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)92884-V"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v31.i37.110269"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2002.01251.x"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1392408"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2013.10.010"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2012.08.021"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000090"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2017.07.008"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-017-0599-4"},{"issue":"8","key":"e_1_2_11_56_1","article-title":"Pharmacological Prevention of Post\u2010Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Where Do we Stand Now?","volume":"12","author":"Ahmad W.","year":"2020","journal-title":"Cureus"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1111103"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.12.043"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2024-334466"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010025\u201009618\u20103"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02870707"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02356-5"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.12.040"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2023.11.003"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfz062"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-017-0673-8"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.03.023"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001523"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajg.2022.01.004"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000001903"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2021.410"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2021.07.005"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001712"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-98969-y"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl220268"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000038764"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.07.026"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.06.007"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000856"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1834-6568"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2019.07.046"},{"issue":"5","key":"e_1_2_11_82_1","article-title":"Aggressive Hydration With Ringer's Lactate in the Prevention of Post\u2010ERCP Pancreatitis: A Meta\u2010Analysis","volume":"13","author":"Aljohani S.","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_11_83_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09808-4"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_11_85_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1511175"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1313"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.19.5.823"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.5114\/ait.2021.105252"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14070741"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1255781"},{"key":"e_1_2_11_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2006.07.031"},{"key":"e_1_2_11_92_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i22.7040"},{"key":"e_1_2_11_93_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i24.7577"},{"key":"e_1_2_11_94_1","doi-asserted-by":"publisher","DOI":"10.1159\/000106774"},{"key":"e_1_2_11_95_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1365701"},{"key":"e_1_2_11_96_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2023.01.049"},{"key":"e_1_2_11_97_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2105395"},{"key":"e_1_2_11_98_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.07.033"},{"issue":"1","key":"e_1_2_11_99_1","first-page":"15","article-title":"Double\u2010Guidewire Technique in Difficult Biliary Cannulation for the Prevention of Post\u2010ERCP Pancreatitis: A Systematic Review and Meta\u2010Analysis","volume":"49","author":"Tse F.","year":"2017","journal-title":"Endoscopy"},{"key":"e_1_2_11_100_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2009.06010.x"},{"key":"e_1_2_11_101_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14453"},{"key":"e_1_2_11_102_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012213"},{"key":"e_1_2_11_103_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-96142-9"},{"key":"e_1_2_11_104_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.06.064"},{"key":"e_1_2_11_105_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.09.024"},{"key":"e_1_2_11_106_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1443-1661.2008.00819.x"},{"key":"e_1_2_11_107_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.11.014"}],"container-title":["Geriatrics &amp; Gerontology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ggi.70548","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ggi.70548","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ggi.70548","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:02:08Z","timestamp":1779771728000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ggi.70548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":106,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/ggi.70548"],"URL":"https:\/\/doi.org\/10.1111\/ggi.70548","archive":["Portico"],"relation":{},"ISSN":["1444-1586","1447-0594"],"issn-type":[{"value":"1444-1586","type":"print"},{"value":"1447-0594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2026-03-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70548"}}