Self-expandable metallic stents for malignant biliary obstruction with an anomalous pancreaticobiliary junction

Kogure, Hirofumi; Tsujino, Takeshi; Yagioka, Hiroshi; Sasaki, Takashi; Nakai, Yousuke; Hirano, Keisuke; Sasahira, Naoki; Isayama, Hiroyuki; Tada, Minoru; Kawabe, Takao; Omata, Masao

doi:10.1007/s00464-007-9482-7

Cited by 3 publications

(3 citation statements)

References 22 publications

(35 reference statements)

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“…Of the included studies, there were three randomized controlled studies, 37 prospective cohort studies, and 29 retrospective cohort studies. There were 35 studies from which data could be abstracted on patients over 65 6 13 19 23 31 32 33 34 35 47 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 and over 80 5 6 10 11 14 15 20 25 26 28 31 33 36 37 38 39 40 41 48 49 55 56 57 60 64 66 67 69 71 75 76 77 78 79 80 in which 10 286 and 4036 ERCPs had been performed, respectively; 19 studies were available from which data could be abstracted on patients over 9...…”

Section: Resultsmentioning

confidence: 99%

“…With respect to individual adverse events in patients aged ≥ 65 years of age, the rate of pancreatitis was 13.1 /1000 ERCPs (95 %CI 11.0 – 15.5) 13 19 23 31 32 33 34 35 47 51 52 53 54 55 56 58 59 60 61 62 63 64 66 67 68 69 70 72 73 74 75 83 , perforation rate was 3.8 /1000 ERCPs (95 %CI 1.8 – 7.0) 13 19 23 31 32 33 34 35 47 51 52 53 55 58 59 60 61 62 63 64 66 67 68 69 72 74 75 83 , and bleeding rate was 7.7 /1000 ERCPs (95 %CI 5.7 – 10.1) 13 19 23 31 32 33 34 35 47 51 …”

Section: Resultsmentioning

confidence: 99%

“…The lowest adverse event incidence rates in octogenarians were for perforation and cholangitis, while cardiopulmonary adverse events were the most frequently reported 10 11 14 15 25 28 31 33 36 38 40 48 49 55 60 64 66 67 69 75 76 77 83 . Additionally, the mortality rate was 6.1 deaths/1000 ERCPs (95 %CI 3.8 – 9.2) 5 10 11 14 15 20 25 26 28 31 33 36 37 38 40 41 48 49 55 56 57 60 64 66 67 69 75 76 77 78 79 83 , with 22 documented deaths among 32 of the studies involving octogenarians. Lastly, among patients ≥ 90, the most frequent adverse event was bleeding with an incidence rate of 28.6/1000 ERCPs (95 %CI 17.8 – 43.3) 10 11 17 20 24 27 42 43 44 45 46 50 ...…”

Section: Resultsmentioning

confidence: 99%

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Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis

Day

Lin

Somsouk

2014

EIO

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Background and study aims: Biliary and pancreatic diseases are common in the elderly; however, few studies have addressed the occurrence of adverse events in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Our objective was to determine the incidence rates of specific adverse events in this group and calculate incidence rate ratios (IRRs) for selected comparison groups. Patients and methods: Bibliographical searches were conducted in Medline, EMBASE, and Cochrane library databases. The studies included documented the incidence of adverse events (perforation, pancreatitis, bleeding, cholangitis, cardiopulmonary adverse events, mortality) in patients aged ≥ 65 who underwent ERCP. Pooled incidence rates were calculated for each reported adverse event and IRRs were determined for available comparison groups. A parallel analysis was performed in patients aged ≥ 80 and ≥ 90. Results: Our literature search yielded 7429 articles, of which 69 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 ERCPs) in patients aged ≥ 65 were as follows: perforation 3.8 (95 %CI 1.8 – 7.0), pancreatitis 13.1 (95 %CI 11.0 – 15.5), bleeding 7.7 (95 %CI 5.7 – 10.1), cholangitis 16.1 (95 %CI 11.7 – 21.7), cardiopulmonary events 3.7 (95 %CI 1.5 – 7.6), and death 7.1 (95 %CI 5.2 – 9.4). Patients ≥ 65 had lower rates of pancreatitis (IRR 0.3, 95 %CI 0.3 – 0.4) compared with younger patients. Octogenarians had higher rates of death (IRR 2.4, 95 %CI 1.3 – 4.5) compared with younger patients, whereas nonagenarians had increased rates of bleeding (IRR 2.4, 95 %CI 1.1 – 5.2), cardiopulmonary events (IRR 3.7, 95 %CI 1.0 – 13.9), and death (IRR 3.8, 95 %CI 1.0 – 14.4). Conclusions ERCP appears to be safe in elderly patients, except in the very elderly who are at higher risk of some adverse events. These data on adverse event rates can help to inform clinical decision-making, the consent process, and comparative effectiveness analyses.

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