Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Endoscopic removal of common bile duct stones in nonagenarians: a tertiary center experience

  • Mustafa Jalal (Department of Gastroenterology, Northern General Hospital) ;
  • Amaan Khan (Department of Gastroenterology, Northern General Hospital) ;
  • Sijjad Ijaz (Department of Gastroenterology, Northern General Hospital) ;
  • Mohammed Gariballa (Department of Gastroenterology, Northern General Hospital) ;
  • Yasser El-Sherif (Department of Gastroenterology, Northern General Hospital) ;
  • Amer Al-Joudeh (Department of Gastroenterology, Northern General Hospital)
  • Received : 2021.12.07
  • Accepted : 2022.02.04
  • Published : 2023.01.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians. Methods: We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups. Results: A total of 125 nonagenarians were compared with 1,370 controls (65-89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days. Conclusions: Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.

Keywords

References

  1. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects 2019: highlights. New York (NY): United Nations; 2019. 
  2. NHS. Hospital admissions hit record high as population ages. Leeds: NHS Digital; 2016. 
  3. Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am Surg 1986;52:442-445. 
  4. Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: management and outcomes. Gut 1997;41:433-435.  https://doi.org/10.1136/gut.41.4.433
  5. Sullivan DM, Hood TR, Griffen WO Jr. Biliary tract surgery in the elderly. Am J Surg 1982;143:218-220.  https://doi.org/10.1016/0002-9610(82)90072-1
  6. Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017;66:765-782.  https://doi.org/10.1136/gutjnl-2016-312317
  7. Ashton CE, McNabb WR, Wilkinson ML, et al. Endoscopic retrograde cholangiopancreatography in elderly patients. Age Ageing 1998;27:683-688.  https://doi.org/10.1093/ageing/27.6.683
  8. Ross SO, Forsmark CE. Pancreatic and biliary disorders in the elderly. Gastroenterol Clin North Am 2001;30:531-545, x.  https://doi.org/10.1016/S0889-8553(05)70194-1
  9. National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Scoping our practice (2004) [Internet]. London: NCEPOD; 2004 [cited 2021 Dec 6]. Available from: https://www.ncepod.org.uk/2004sop.html. 
  10. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2020;52:127-149.  https://doi.org/10.1055/a-1075-4080
  11. Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc 2000;52:187-191.  https://doi.org/10.1067/mge.2000.107285
  12. Rodriguez-Gonzalez FJ, Naranjo-Rodriguez A, Mata-Tapia I, et al. ERCP in patients 90 years of age and older. Gastrointest Endosc 2003;58:220-225.  https://doi.org/10.1067/mge.2003.363
  13. Mitchell RM, O'Connor F, Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol 2003;36:72-74.  https://doi.org/10.1097/00004836-200301000-00019
  14. Hui CK, Liu CL, Lai KC, et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Aliment Pharmacol Ther 2004;19:1153-1158.  https://doi.org/10.1111/j.1365-2036.2004.01962.x
  15. Huguet JM, Sempere J, Bort I, et al. Complications of endoscopic retrograde cholangiopancreatography in patients aged more than 90 years old. Gastroenterol Hepatol 2005;28:263-266.  https://doi.org/10.1157/13074059
  16. Cariani G, Di Marco M, Roda E, et al. Efficacy and safety of ERCP in patients 90 years of age and older. Gastrointest Endosc 2006;64:471-472.  https://doi.org/10.1016/j.gie.2006.04.005
  17. Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older. Gastrointest Endosc 2006;63:417-423.  https://doi.org/10.1016/j.gie.2005.09.051
  18. Gronroos JM, Salminen P, Laine S, et al. Feasibility of ERCP procedures in patients 90 years of age and older. J Clin Gastroenterol 2010;44:227-228.  https://doi.org/10.1097/MCG.0b013e3181b3830f
  19. Hu L, Sun X, Hao J, et al. Long-term follow-up of therapeutic ERCP in 78 patients aged 90 years or older. Sci Rep 2014;4:4918. 
  20. Yun DY, Han J, Oh JS, et al. Is endoscopic retrograde cholangiopancreatography safe in patients 90 years of age and older? Gut Liver 2014;8:552-556.  https://doi.org/10.5009/gnl13310
  21. Sobani ZA, Yunina D, Abbasi A, et al. Endoscopic retrograde cholangiopancreatography in nonagenarian patients: is it really safe? Clin Endosc 2018;51:375-380.  https://doi.org/10.5946/ce.2017.123
  22. Saito H, Koga T, Sakaguchi M, et al. Safety and efficacy of endoscopic removal of common bile duct stones in elderly patients ≥90 years of age. Intern Med 2019;58:2125-2132.  https://doi.org/10.2169/internalmedicine.2546-18
  23. Ogiwara S, Furihata M, Inami Y, et al. Does Endoscopic retrograde cholangiopancreatography carry higher risk for patients 90 years and older? A single-institution retrospective study. Med Sci Monit 2020;26:e928033. 
  24. Nakata B, Amano R, Kimura K, et al. Comparison of prognosis between patients of pancreatic head cancer with and without obstructive jaundice at diagnosis. Int J Surg 2013;11:344-349.  https://doi.org/10.1016/j.ijsu.2013.02.023
  25. Waseem D, Tushar P. Intrahepatic, perihilar and distal cholangiocarcinoma: management and outcomes. Ann Hepatol 2017;16:133-139.  https://doi.org/10.5604/16652681.1226927
  26. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425-434.  https://doi.org/10.1067/mge.2001.117550
  27. Finkelmeier F, Tal A, Ajouaou M, et al. ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis. Gastrointest Endosc 2015;82:1051-1059.  https://doi.org/10.1016/j.gie.2015.04.032
  28. Schmitz-Moormann P, Himmelmann GW, Brandes JW, et al. Comparative radiological and morphological study of human pancreas. Pancreatitis like changes in postmortem ductograms and their morphological pattern. Possible implication for ERCP. Gut 1985;26:406-414.  https://doi.org/10.1136/gut.26.4.406
  29. Herzig KH, Purhonen AK, Rasanen KM, et al. Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus. BMC Geriatr 2011;11:4. 
  30. Friedrich K, Scholl SG, Beck S, et al. Respiratory complications in outpatient endoscopy with endoscopist-directed sedation. J Gastrointestin Liver Dis 2014;23:255-259.  https://doi.org/10.15403/jgld.2014.1121.233.kf1
  31. Kollmann CM, Schmiegel W, Brechmann T. Gastrointestinal endoscopy under sedation is associated with pneumonia in older inpatients-results of a retrospective case-control study. United European Gastroenterol J 2018;6:382-390.  https://doi.org/10.1177/2050640617735059
  32. Fisher L, Fisher A, Thomson A. Cardiopulmonary complications of ERCP in older patients. Gastrointest Endosc 2006;63:948-955.  https://doi.org/10.1016/j.gie.2005.09.020
  33. Navaneethan U, Njei B, Zhu X, et al. Safety of ERCP in patients with liver cirrhosis: a national database study. Endosc Int Open 2017;5:E303-E314.  https://doi.org/10.1055/s-0043-102492
  34. Sawas T, Bazerbachi F, Haffar S, et al. End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients. World J Gastroenterol 2018;24:4691-4697.  https://doi.org/10.3748/wjg.v24.i41.4691
  35. Navaneethan U, Gutierrez NG, Jegadeesan R, et al. Factors predicting adverse short-term outcomes in patients with acute cholangitis undergoing ERCP: a single center experience. World J Gastrointest Endosc 2014;6:74-81.  https://doi.org/10.4253/wjge.v6.i3.74
  36. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  https://doi.org/10.1016/S0140-6736(20)30183-5
  37. Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020;158:1518-1519.  https://doi.org/10.1053/j.gastro.2020.02.054
  38. Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc 2013;5:527-533. https://doi.org/10.4253/wjge.v5.i11.527