Safety and efficacy of enhanced recovery after surgery in elderly patients after therapeutic endoscopic retrograde cholangiopancreatography.

Abstract

IntroductionThe number of elderly patients with biliary and pancreatic diseases has increased significantly. The characteristics of biliary and pancreatic diseases in the elderly increase the risk of treatment.AimTo study the safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with biliary and pancreatic diseases with the concept of enhanced recovery after surgery (ERAS).Material and methodsPatients receiving ERCP under ERAS were grouped into an elderly group (group A, n = 58, aged 75 years or above) and a young and middle-aged group (group B, n = 202, aged less than 60 years). The clinical parameters before, during and after the operation of the two groups were compared.ResultsBefore the operation, the incidences of cholangiocarcinoma and complications, nutritional screening score ≥ 3, ASA degree III and Child-Pugh grade A in group A were significantly higher than those in group B (p < 0.05), while the incidences of nausea and vomiting, abdominal pain, nutritional screening < 3 and ASA grade I in group A were significantly lower than those in group B (p < 0.05). Intraoperatively, the incidence of juxta-ampullary duodenal diverticulum (JAD) in internal or bottom papilla in the elder patients with difficult selective biliary cannulation (DSBC) was significantly higher than that in the young and middle-aged group (p < 0.05). In addition, the continuous ECG monitoring duration and the first exhaust time in group A were significantly longer than those in group B (p < 0.05).ConclusionsEndoscopic retrograde cholangiopancreatography under ERAS in elderly patients is as safe and effective as in young patients.

Comparison of the procedure results of ectopic papillae encountered during ERCP procedure with the procedure results of papillae with normal localization

“…Patients with ectopic papillae are difficult to cannulate [25][26][27][28]. Disibeyaz et al [6] successfully removed stones in 59% of the patients with stones in the common bile duct when compared with another study involving ectopic bulbar papilla series.…”

Recent advances in prevention and management of endoscopic retrograde cholangiopancreatography-related duodenal perforation.

“…Patil et al [ 4 ] also reported that 30% of patients with perforations had a history of difficult canulation, 20% had a pre-cut history, and 8% had a history of papillary incision. The new study of Niu et al [ 3 ] showed that senility did not increase the risk of perforation.…”

“…ERCP-related techniques include endoscopic sphincterotomy (EST), endoscopic papillary balloon dilatation (EPBD), endoscopic nasobiliary drainage (ENBD), endoscopic retrograde pancreatic drainage (ERPD), bile duct or pancreatic duct stent placement, and bile duct or pancreatic duct stone removal. ERCP is more difficult than other endoscopic techniques and has a unique set of complications associated with it that include acute pancreatitis, biliary tract infection, gastrointestinal bleeding, and perforation; some of these are extremely dangerous, such as duodenal perforation [1][2][3].…”

Clinical application of enhanced recovery after surgery in the treatment of choledocholithiasis by ERCP

“…[ 1 ] ERAS comprises a series of evidence-based optimization measures incorporated into perioperative treatment. [ 2 ] Multi-dimensional and comprehensive care, combined with surgery and anesthesia techniques, can reduce patients’ physiological and psychological traumatic stress, lowering the incidence of postoperative complications and allowing patients to recover quickly. [ 3 , 4 ] ERAS has overturned the perioperative management thinking formed over the past hundred years, and several previous studies have reported obvious advantages over traditional methods for shortening hospital stays, lowering the incidence of postoperative complications and mortality, and reducing medical costs.…”