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Erschienen in: Digestive Diseases and Sciences 7/2016

12.02.2016 | Original Article

Efficacy and Safety of Therapeutic Endoscopic Retrograde Cholangiopancreatography in the Elderly Over 80 Years

verfasst von: Su Jung Han, Tae Hoon Lee, Byong Il Kang, Hyun Jong Choi, Yun Nah Lee, Sang-Woo Cha, Jong Ho Moon, Young Deok Cho, Sang Hum Park, Sun-Joo Kim

Erschienen in: Digestive Diseases and Sciences | Ausgabe 7/2016

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Abstract

Background/Aims

Concern regarding the safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients is increasing as a result of the aging society. However, there are limited data, especially in the super-aged elderly. This study aimed to evaluate the efficacy and safety of therapeutic ERCP in patients ≥80 years of age.

Methods

Patients 80 years of age or older (n = 312) and younger than 65 years (n = 312) who underwent therapeutic ERCP from June 2006 to April 2014 were randomly selected and analyzed retrospectively. The main outcome measurements were therapeutic ERCP-related complications and clinical outcomes in the two groups.

Results

Choledocholithiasis combined with gallbladder stone was the most common indication for ERCP in both groups. Comorbid diseases (70.5 and 29.8 %, p < 0.001) and the use of anti-thrombotic drugs (18.6 and 1.6 %, p < 0.001) were more frequent in the super-aged group. The mean procedure time was longer, and the frequency of second ERCP was more common in the super-aged group. However, the technical success rate (94.9 and 97.4 %, p = 0.096) and the procedure-related complication rate (4.8 and 5.8 %, p = 0.592) were not different between the two groups. Post-ERCP pancreatitis occurred in 1.3 % of the super-aged group and in 2.9 % of the control group (p = 0.262). Cardiopulmonary complications occurred in 1.9 % of patients in each group (p = 1.0).

Conclusions

Therapeutic ERCP is comparable in terms of efficacy and safety between patients ≥80 years and those <65 years of age, although the elderly group had a higher rate of comorbid diseases and used anti-thrombotic drugs more frequently.
Literatur
1.
Zurück zum Zitat Croker JR. Biliary tract disease in the elderly. Clin Gastroenterol. 1985;14:773–809.PubMed Croker JR. Biliary tract disease in the elderly. Clin Gastroenterol. 1985;14:773–809.PubMed
2.
Zurück zum Zitat Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am Surg. 1986;52:442–445.PubMed Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am Surg. 1986;52:442–445.PubMed
3.
Zurück zum Zitat Kim JE, Cha BH, Lee SH, et al. Safety and efficacy of endoscopic retrograde cholangiopancreatography in very elderly patients. Korean J Gastroenterol. 2011;57:237.CrossRefPubMed Kim JE, Cha BH, Lee SH, et al. Safety and efficacy of endoscopic retrograde cholangiopancreatography in very elderly patients. Korean J Gastroenterol. 2011;57:237.CrossRefPubMed
4.
Zurück zum Zitat Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.CrossRefPubMed Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.CrossRefPubMed
5.
Zurück zum Zitat Lukens FJ, Howell DA, Upender S, Sheth SG, Jafri SM. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci. 2010;55:847–851.CrossRefPubMed Lukens FJ, Howell DA, Upender S, Sheth SG, Jafri SM. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci. 2010;55:847–851.CrossRefPubMed
6.
Zurück zum Zitat Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000;52:187–191.CrossRefPubMed Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000;52:187–191.CrossRefPubMed
7.
Zurück zum Zitat Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10.CrossRefPubMed Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10.CrossRefPubMed
8.
Zurück zum Zitat Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.CrossRefPubMed Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.CrossRefPubMed
10.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
11.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
12.
Zurück zum Zitat Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417–423.CrossRefPubMed Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417–423.CrossRefPubMed
13.
Zurück zum Zitat Rustagi T, Jamidar PA. Endoscopic retrograde cholangiopancreatography-related adverse events: general overview. Gastrointest Endosc Clin N Am. 2015;25:97–106.CrossRefPubMed Rustagi T, Jamidar PA. Endoscopic retrograde cholangiopancreatography-related adverse events: general overview. Gastrointest Endosc Clin N Am. 2015;25:97–106.CrossRefPubMed
14.
Zurück zum Zitat Cho DH, Park GT, Oh JE, et al. A single institution’s experience of endoscopic retrograde cholangiopancreaticography in the elderly patients: outcomes safety and complications. Korean J Gastroenterol. 2011;58:88–92.CrossRefPubMed Cho DH, Park GT, Oh JE, et al. A single institution’s experience of endoscopic retrograde cholangiopancreaticography in the elderly patients: outcomes safety and complications. Korean J Gastroenterol. 2011;58:88–92.CrossRefPubMed
15.
Zurück zum Zitat Cocking JB, Ferguson A, Mukherjee SK, Giancola G. Short-acting general anaesthesia facilitates therapeutic ERCP in frail elderly patients with benign extra-hepatic biliary disease. Eur J gastroenterol Hepatol. 2000;12:451–454.CrossRefPubMed Cocking JB, Ferguson A, Mukherjee SK, Giancola G. Short-acting general anaesthesia facilitates therapeutic ERCP in frail elderly patients with benign extra-hepatic biliary disease. Eur J gastroenterol Hepatol. 2000;12:451–454.CrossRefPubMed
16.
17.
Zurück zum Zitat Lillemoe KD. Pancreatic disease in the elderly patient. Surg Clin North Am. 1994;74:317–344.PubMed Lillemoe KD. Pancreatic disease in the elderly patient. Surg Clin North Am. 1994;74:317–344.PubMed
18.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc. 2006;64:899–905.CrossRefPubMed Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc. 2006;64:899–905.CrossRefPubMed
20.
Zurück zum Zitat Katsinelos P, Lazaraki G, Chatzimavroudis G, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol. 2014;27:65–72.PubMedPubMedCentral Katsinelos P, Lazaraki G, Chatzimavroudis G, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol. 2014;27:65–72.PubMedPubMedCentral
21.
Zurück zum Zitat Boustiere C, Veitch A, Vanbiervliet G, et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2011;43:445–461.CrossRefPubMed Boustiere C, Veitch A, Vanbiervliet G, et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2011;43:445–461.CrossRefPubMed
22.
Zurück zum Zitat Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther. 2003;17:1493–1501.CrossRefPubMed Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther. 2003;17:1493–1501.CrossRefPubMed
23.
Zurück zum Zitat Amornyotin S, Leelakusolvong S, Chalayonnawin W, Kongphlay S. Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country. Clin Exp Gastroenterol. 2012;5:123–128.CrossRefPubMedPubMedCentral Amornyotin S, Leelakusolvong S, Chalayonnawin W, Kongphlay S. Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country. Clin Exp Gastroenterol. 2012;5:123–128.CrossRefPubMedPubMedCentral
Metadaten
Titel
Efficacy and Safety of Therapeutic Endoscopic Retrograde Cholangiopancreatography in the Elderly Over 80 Years
verfasst von
Su Jung Han
Tae Hoon Lee
Byong Il Kang
Hyun Jong Choi
Yun Nah Lee
Sang-Woo Cha
Jong Ho Moon
Young Deok Cho
Sang Hum Park
Sun-Joo Kim
Publikationsdatum
12.02.2016
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 7/2016
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-016-4064-y

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