Endoscopic removal of common bile duct stones in nonagenarians: a tertiary centre experience
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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 ofendoscopic 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 nonagenarianswas significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenariansand controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarianshad 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 ofpost-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.
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 ofendoscopic 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 nonagenarianswas significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenariansand controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarianshad 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 ofpost-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.
참고문헌 (38)
- United Nations, Department of Economic and Social Affairs, Population Division, "World population prospects 2019: highlights", United Nations, ~ (2019)
- NHS, "Hospital admissions hit record high as population ages", NHS Digital, ~ (2016)
- Harness JK, "Symptomatic biliary tract disease in the elderly patient", Am Surg, 52, pp.442~445 (1986)
- Siegel JH, "Biliary tract diseases in the elderly : management and outcomes", Gut, 41, pp.433~435 (1997)
- Sullivan DM, "Biliary tract surgery in the elderly", Am J Surg, 143, pp.218~220 (1982)
- Williams E, "Updated guideline on the management of common bile duct stones(CBDS)", Gut, 66, pp.765~782 (2017)
- Ashton CE, "Endoscopic retrograde cholangiopancreatography in elderly patients", Age Ageing, 27, pp.683~688 (1998)
- Ross SO, "Pancreatic and biliary disorders in the elderly", Gastroenterol Clin North Am, 30, pp.531~545 (2001)
- "Scoping our practice (2004)" (2004)[URL]
- Dumonceau JM, "ERCP-related adverse events : European Society of Gastrointestinal Endoscopy(ESGE)guideline", Endoscopy, 52, pp.127~149 (2020)
- Sugiyama M, "Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older", Gastrointest Endosc, 52, pp.187~191 (2000)
- Rodríguez-González FJ, "ERCP in patients 90 years of age and older", Gastrointest Endosc, 58, pp.220~225 (2003)
- Mitchell RM, "Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older", J Clin Gastroenterol, 36, pp.72~74 (2003)
- Hui CK, "Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older", Aliment Pharmacol Ther, 19, pp.1153~1158 (2004)
- Huguet JM, "Complications of endoscopic retrograde cholangiopancreatography in patients aged more than 90 years old", Gastroenterol Hepatol, 28, pp.263~266 (2005)
- Cariani G, "Efficacy and safety of ERCP in patients 90 years of age and older", Gastrointest Endosc, 64, pp.471~472 (2006)
- Katsinelos P, "Efficacy and safety of therapeutic ERCP in patients 90 years of age and older", Gastrointest Endosc, 63, pp.417~423 (2006)
- Grönroos JM, "Feasibility of ERCP procedures in patients 90 years of age and older", J Clin Gastroenterol, 44, pp.227~228 (2010)
- Hu L, "Long-term follow-up of therapeutic ERCP in 78 patients aged 90 years or older", Sci Rep, 4, pp.4918~ (2014)
- 윤대영, "Is Endoscopic Retrograde Cholangiopancreatography Safe in Patients 90 Years of Age and Older?", Gut and Liver, 8(5), pp.552~556 (2014), 거트앤리버 소화기연관학회협의회
- Zain A Sobani, "Endoscopic Retrograde Cholangiopancreatography in Nonagenarian Patients: Is It Really Safe?", Clinical Endoscopy, 51(4), pp.375~380 (2018), 대한소화기내시경학회
- Saito H, "Safety and efficacy of endoscopic removal of common bile duct stones in elderly patients ≥90 years of age", Intern Med, 58, pp.2125~2132 (2019)
- Ogiwara S, "Does Endoscopic retrograde cholangiopancreatography carry higher risk for patients 90 years and older? A single-institution retrospective study", Med Sci Monit, 26, pp.e928033~ (2020)
- Nakata B, "Comparison of prognosis between patients of pancreatic head cancer with and without obstructive jaundice at diagnosis", Int J Surg, 11, pp.344~349 (2013)
- Waseem D, "Intrahepatic, perihilar and distal cholangiocarcinoma : management and outcomes", Ann Hepatol, 16, pp.133~139 (2017)
- Freeman ML, "Risk factors for post-ERCP pancreatitis : a prospective, multicenter study", Gastrointest Endosc, 54, pp.425~434 (2001)
- Finkelmeier F, "ERCP in elderly patients : increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis", Gastrointest Endosc, 82, pp.1051~1059 (2015)
- Schmitz-Moormann P, "Comparative radiological and morphological study of human pancreas. Pancreatitis like changes in postmortem ductograms and their morphological pattern. Possible implication for ERCP", Gut, 26, pp.406~414 (1985)
- Herzig KH, "Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus", BMC Geriatr, 11, pp.4~ (2011)
- Friedrich K, "Respiratory complications in outpatient endoscopy with endoscopist-directed sedation", J Gastrointestin Liver Dis, 23, pp.255~259 (2014)
- Kollmann CM, "Gastrointestinal endoscopy under sedation is associated with pneumonia in older inpatients-results of a retrospective case-control study", United European Gastroenterol J, 6, pp.382~390 (2018)
- Fisher L, "Cardiopulmonary complications of ERCP in older patients", Gastrointest Endosc, 63, pp.948~955 (2006)
- Navaneethan U, "Safety of ERCP in patients with liver cirrhosis : a national database study", Endosc Int Open, 5, pp.E303~ (2017)
- Sawas T, "End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients", World J Gastroenterol, 24, pp.4691~4697 (2018)
- Navaneethan U, "Factors predicting adverse short-term outcomes in patients with acute cholangitis undergoing ERCP : a single center experience", World J Gastrointest Endosc, 6, pp.74~81 (2014)
- Huang C, "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China", Lancet, 395, pp.497~506 (2020)
- Gu J, "COVID-19 : gastrointestinal manifestations and potential fecal-oral transmission", Gastroenterology, 158, pp.1518~1519 (2020)
- Amornyotin S, "Sedation-related complications in gastrointestinal endoscopy", World J Gastrointest Endosc, 5, pp.527~533 (2013)