Long-term follow-up of therapeutic ERCP in 78 patients aged 90 years or older

Lianghao Hu, Xiaotian Sun, Junfeng Hao, Ting Xie, Minghao Liu, Lei Xin, Tao Sun, Muyun Liu, Wenbin Zou, Bo Ye, Feng Liu, Dong Wang, Ning Cao, Zhuan Liao, Zhaoshen Li, Lianghao Hu, Xiaotian Sun, Junfeng Hao, Ting Xie, Minghao Liu, Lei Xin, Tao Sun, Muyun Liu, Wenbin Zou, Bo Ye, Feng Liu, Dong Wang, Ning Cao, Zhuan Liao, Zhaoshen Li

Abstract

This study aimed to determine the performance and long-term outcomes of therapeutic ERCP in very old patients. Patients aged or over 90 (Group A, n = 78) and consecutive sex-matched controls (Group B, n = 312) under 65 selected were compared. More patients in Group A had chronic concomitant diseases, but the success and complication rates were comparable. The follow-up of 61 patients (78.2%) in Group A were done, with a mean period of 27.5 (3-54) months. Seven patients survived; the main causes of death for the other patients were concomitant diseases (n = 43) and primary diseases (n = 11). In patients with choledocholithiasis, cases with complete extractions of stones in bile ducts survived longer than those without (30 vs. 24 months, P < 0.001). Therapeutic ERCP in patients aged 90 years or older is effective and safe. In patients with choledocholithiasis, complete clearance of stones is associated with longer survival time.

Figures

Figure 1. Kaplan-Meier survival curves: A) for…
Figure 1. Kaplan-Meier survival curves: A) for patients aged over 90 years with choledocholithiasis (green) and cancers (blue): and B) for old patients aged over 90 years with choledocholithiasis only in whom bile duct stones were completely removed (green) or incompletely removed (blue).

References

    1. World Health Organization. World Health Report 2003: shaping the future. Geneva: World Health Organization (2003).
    1. Ross S. O. & Forsmark C. E. Pancreatic and biliary disorders in the elderly. Gastroenterol Clin North Am 30, 531–545 (2001).
    1. Mönkemüller K., Fry L. C., Malfertheiner P. & Schuckardt W. Gastrointestinal endoscopy in the elderly: current issues. Best Pract Res Clin Gastroenterol 23, 821–827 (2009).
    1. Clarke G. A., Jacobson B. C., Hammett R. J. & Carr-Locke D. L. The indications, utilization and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy 33, 580–584 (2001).
    1. Hui C. K. et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Aliment Pharmacol Ther 19, 1153–1158 (2004).
    1. Katsinelos P. et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older. Gastrointest Endosc 63, 417–423 (2006).
    1. Sugiyama M. & Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc 52, 187–191 (2000).
    1. Owens W. D., Felts J. A. & Spitznagel E. L. Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49, 239–243 (1978).
    1. Li Z. S. et al. A long-term follow-up study on endoscopic management of children and adolescents with chronic pancreatitis. Am J Gastroenterol 105, 1884–1892 (2010).
    1. Schutz S. M. & Abbott R. M. Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data. Gastrointest Endosc 51, 535–539 (2000).
    1. Cotton P. B. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37, 383–393 (1991).
    1. Liao Z. et al. China ERCP Live Demonstration and Education Study Group. How safe and successful are live demonstrations of therapeutic ERCP? A large multicenter study. Am J Gastroenterol 104, 47–52 (2009).
    1. Ganzalez J. J. et al. Biliary lithiasis in the elderly patient: morbidity and mortality due to biliary surgery. Hepatogastroenterology 44, 1565–1568 (1997).
    1. Lei W. Y., Chang W. H. Endoscopic retrograde cholangiopancreatography in elderly patients. Int J Gerontol 1, 83–88 (2007).
    1. Cohen J. R., Johnson H., Eaton S., Sterman H. & Wise L. Surgical procedures in patients during the tenth decade of life. Surgery 104, 646–651 (1988).
    1. Salminen P. & Grönroos J. M. Anesthesiologist assistance in endoscopic retrograde cholangiopancreatography procedures in the elderly: is it worthwhile? J Laparoendosc Adv Surg Tech A 21, 517–519 (2011).
    1. Smith A. C., Dowsett J. F., Russell R. C., Hatfield A. R. & Cotton P. B. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 344, 1655–1660 (1994).
    1. Ashton C. E., McNabb W. R., Wilkinson M. L. & Lewis R. R. Endoscopic retrograde cholangiopancreatography in elderly patients. Age Ageing 27, 683–688 (1998).
    1. Mac Mahon M., Walsh T. N., Brennan P., Osborne H. & Courtney M. G. Endoscopic retrograde cholangiopancreatography in the elderly: a single unit audit. Gerontology 39, 28–32 (1993).
    1. Sorkin B. A., Rudy T. E., Hanlon R. B., Turk D. C. & Stieg R. L. Chronic pain in old and young patients: differences appear less important than similarities. J Gerontol 45, 64–68 (1990).
    1. Freeman M. L. Complications of endoscopic biliary sphincterotomy: a review. Endoscopy. 29, 288–297 (1997).
    1. Lobo D. N., Balfour T. W. & Iftikhar S. Y. Periampullary diverticula: consequences of failed ERCP. Ann R Coll Surg Engl 80, 326–331 (1998).
    1. Tyagi P., Sharma P., Sharma B. C. & Puri A. S. Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc 23, 1342–1345 (2009).
    1. Loperfido S. et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48, 1–10 (1998).
    1. American Society for Gastrointestinal Endoscopy. Complications of ERCP. Gastrointest Endosc 57, 633–638 (2003).
    1. Mitchell R. M., O'Connor F. & Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol 36, 72–74 (2003).
    1. Rodríguez-González F. J. et al. ERCP in patients 90 years of age and older. Gastrointest Endosc 58, 220–225 (2003).

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