Efficacy and Safety of Therapeutic ERCP for the Elderly with Choledocholithiasis: Comparison with Younger Patients

Abstract

Objective To clarify the efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography for the elderly with choledocholithiasis compared with younger patients. Methods Consecutive therapeutic ERCPs performed between 2005 and 2007 at our institution for 118 patients aged 80 years or older (group A) and 205 patients younger than 80 years old (group B) were retrospectively reviewed. Successful cannulation rate, complete stone clearance rate, complications and prognosis were compared between the two groups. Results Successful cannulation was achieved in 99.2% in group A versus 99.5% in group B. The complete stone clearance rate was significantly lower in group A than in group B (92.4% versus 99.0%, p<0.01). Plastic stent placement was performed for patients with incomplete duct clearance. There was no significant difference in the early complication rate between group A (5.5%) and group B (6.6%). Procedure-related mortality did not occur. Cholangitis-free survival was similar between the two groups. The short-term prognosis was comparable between those with complete duct clearance and those with biliary stent placement. Conclusion With a duct clearance rate of more than 90% and plastic stent placement for patients with poor general condition, therapeutic ERCP for choledocholithiasis in patients 80 years of age or older is comparable in safety and effectiveness to that in younger patients.

Role of long‐term biliary stenting in choledocholithiasis

“…Because of these significant potential complications, appropriate patient selection is important in the provision of safe ERCP. Our group and others have looked at age as a predictive factor in potential adverse outcomes and found that age alone should not be a determinant in withholding ERCP . Initial outcomes are at least equivalent to a younger cohort.…”

“…Our group and others have looked at age as a predictive factor in potential adverse outcomes and found that age alone should not be a determinant in withholding ERCP. 4,5 Initial outcomes are at least equivalent to a younger cohort. A recent Canadian study found that age was associated with longer procedure times.…”

Comparison of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Magnetic Resonance Cholangiopancreatography (MRCP) in Bile Duct Imaging

“…Two cases had perforations, one had a hemorrhage and one had pacreatitis. T. Obana et al, have observed no mortalities connected to the ERCP procedure [15]. However, low that it may be, ERCP has a mortality rate of 0.7% -0.9% [16].…”

Particularités des urgences chirurgicales du patient âgé

“…La sphinctérotomie endoscopique est particulièrement indiquée chez les malades âgés fragiles avec ou sans antécédent de cholécystectomie ayant une LVP compliquée. L'incidence et la prévalence des complications sont identiques à celles rencontrées chez le sujet plus jeune [31]. Katsinelos et al [32] ont montré des taux très faibles de complications post-CPRE thérapeutiques chez le sujet de 80 ans et plus.…”