Evaluation of endoscopic retrograde cholangiopancreatography success and complications according to age

Year 2019, Volume: 27 Issue: 3, 89 - 92, 25.12.2019

Zehra Paköz , Süleyman Günay Sevil Sarı

https://doi.org/10.17940/endoskopi.667684

Abstract

Background and Aims: Endoscopic retrograde cholangiopancreatography has a higher complication rate than other gastrointestinal endoscopic methods. It is more difficult for elderly patients than for younger patients to recover after surgery, especially when complications occur. This study aimed to evaluate the endoscopic retrograde cholangiopancreatography procedures performed in various age groups and their success and safety in elderly patients.
Material and Methods: Endoscopic retrograde cholangiopancreatography procedures performed in 301 patients in our clinic between January 2018 and June 2018 were retrospectively evaluated. The patients were divided into 3 groups according to their age, i.e., <60 years, between 60 and 80 years, and >80 years[Editor1]. Procedure success, complications, necessity of reprocedure, and indications were evaluated in each group and the results were compared among the groups.
Results: A total of 163 (54.2%) of the patients were women and 138 (45.8%) were men. The most common indication for endoscopic retrograde cholangiopancreatography was bile duct[Editor2] in all patient groups. There was no difference among the groups in terms of procedure success, necessity of reprocedure, and pre-cut incision. While the indications for endoscopic retrograde cholangiopancreatography were similar in groups 2 and 3, benign causes were significantly higher in group 1 than in both groups 2 and 3. There was no statistically significant difference among the groups in terms of complications (p = 0.837). None of these patients experienced perforation, bleeding, or death.
Discussion: We found that endoscopic retrograde cholangiopancreatography success, necessity of reprocedure, and complications were similar among the groups. We conclude that endoscopic retrograde cholangiopancreatography procedure has similar efficacy and safety in elderly patients and younger patients.

Keywords

Endoscopic retrograde cholangiopancreatography, post-ERCP complications

ERCP başarısı ve komplikasyonlarının yaşa göre değerlendirilmesi

Abstract

Giriş ve Amaç: Endoskopik retrograd kolanjiopankreatografi diğer gastrointestinal endoskopik yöntemlere göre daha yüksek komplikasyon oranına sahiptir. Özellikle komplikasyon geliştiğinde, yaşlı hastaların operasyonlar sonrası düzelmesi gençlere göre daha zor olmaktadır. Bu çalışmada amacımız çeşitli yaş gruplarında yapılan endoskopik retrograd kolanjiopankreatografi işlemlerinin değerlendirilmesi ve yaşlı hastalarda işlem başarısı ve güvenilirliğinin değerlendirilmesidir.
Gereç ve Yöntem: Kliniğimizde Ocak 2018-Haziran 2018 tarihleri arasında yapılan 301 hastaya ait endoskopik retrograd kolanjiopankreatografi işlemleri retrospektif olarak değerlendirildi. Hastalar yaşlarına göre 60 yaş altı, 60-80 yaş arası ve 80 yaş üstü olarak 3 gruba ayrıldı. Her grupta işlem başarısı, komplikasyonlar, işlem tekrarı gerekliliği, işlem endikasyonları değerlendirildi ve gruplar birbiriyle karşılaştırıldı.
Bulgular: Hastaların 163’ü (%54.2) kadın ve 138’i (%45.8) erkekti. Tüm hasta gruplarında en sık endoskopik retrograd kolanjiopankreatografi endikasyonu safra taşıydı. İşlem başarısı, işlem tekrarı gerekliliği, pre-cut kesi gerekliği açısından gruplar arası fark saptanmadı. Grup 2 ve 3’de endoskopik retrograd kolanjiopankreatografi endikasyonları benzer iken Grup 1’de Grup 2 ve Grup 3’e göre benign nedenler anlamlı olarak daha fazla saptandı. Komplikasyonlar değerlendirildiğinde gruplar arasında istatiktiksel olarak anlamlı fark saptanmadı (p=0.837). Hastaların hiçbirinde perforasyon, kanama ya da ölüm görülmedi.
Sonuç: Çalışmamızda endoskopik retrograd kolanjiopankreatografi başarısı, işlem tekrarı gerekliliği ve komplikasyonları tüm yaş gruplarında benzer saptadık. Çalışmamız ve literatür eşliğinde yaşlılarda endoskopik retrograd kolanjiopankreatografi işleminin gençler ile benzer etkinlik ve güvenlikte olduğunu düşünmekteyiz.

Keywords

Endoskopik retrograd kolanjiyopankreatografi, post- endoskopik retrograd kolanjiopankreatografi, komplikasyonlar, yaşlı hastalar

References

• 1-Mazen Jamal M, Yoon EJ, Saadi A, Sy TY, Hashemzadeh M. Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol 2007;102:966-75.
• 2-Dalton HR, Chapman RW. Role of biliary stenting in the management of bile duct stones in the elderly. Gut 1995;36:485-7.
• 3-Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781-8.
• 4-ASGE Standards of Practice Committee, Anderson MA, Fisher L, Jain R, et al. Complications of ERCP. Gastrointest Endosc 2012;75:467-73.
• 5-Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: management and outcomes. Gut. 1997;41:433-5.
• 6-Tierney S, Lillemoe KD, Pitt HA. The current management of common duct stones. Adv Surg 1995;28:271-99.
• 7-Provinciali M, Smorlesi A. Immunoprevention and immunotherapy of cancer in ageing. Cancer Immunol Immunother 2005;54:93-106.
• 8-Roy A, Martin D. Complicated bile duct stones. BMJ Case Rep 2013;2013:bcr201300667.
• 9-Rahman SH, Larvin M, McMahon MJ, Thompson D. Clinical presentation and delayed treatment of cholangitis in older people. Dig Dis Sci 2005;50:2207-10.
• 10-Lee F, Ohanian E, Rheem J, et al. Delayed endoscopic retrograde cholangiopancreatography is associated with persistent organ failure in hospitalised patients with acute cholangitis. Aliment Pharmacol Ther 2015;42:212-20.
• 11-Riphaus A, Stergiou N, Wehrmann T. ERCP in octogenerians: a safe and efficient investigation. Age Ageing 2008;37:595-9.
• 12-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.
• 13-Katsinelos P, Kountouras J, Chatzimavroudis G, et al. Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older. Endoscopy 2011;43:128-33.
• 14-Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909-18.
• 15-Han SJ, Lee TH, Kang BI et al. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years. Dig Dis Sci 2016;61:2094-101.
• 16-Park CS, Jeong HS, Kim KB, et al. Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients. Hepatobiliary Pancreat Dis Int 2016;15:619-25.
• 17-Kim JE, Cha BH, Lee SH, et al. Safety and efficacy of endoscopic retrograde cholangiopan-creatograpy in very elderly patients. Korean J Gastroenterol 2011;57:237-42.
• 18-Cotton PB. Endoscopic management of bile duct stones; (apples and oranges). Gut 1984;25:587-97.
• 19-Agarwal N, Sharma BC, Sarin SK. Endoscopic management of acute cholangitis in elderly patients. World J Gastroenterol 2006;12:6551-5.
• 20-Tohda G, Ohtani M, Dochin M. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly. World J Gastroenterol 2016;22:8382-8.
• 21-Ukkonen M, Siiki A, Antila A, et al. Safety and efficacy of acute endoscopic retrograde cholangiopancreatography in the elderly. Dig Dis Sci 2016;61:3302-8.
• 22-Zippi M, Traversa G, Pica R, et al. Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) performed in patients with periampullary duodenal diverticula (PAD). Clin Ter 2014;165:e291-4.
• 23-Yun DY, Han J, Oh JS, et al. Is endoscopic retrograde cholangiopancreatography safe in patients 90 years of age and older? Gut Liver 2014;8:552-6.
• 24-Takahashi K, Tsuyuguchi T, Sugiyama H, et al. Risk factors of adverse events in endoscopic retrograde cholangiopancreatography for patients aged ≥85 years. Geriatr Gerontol Int 2018;18:1038-45.
• 25-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;58:2125-32.
• 26-Obana T, Fujita N, Noda Y, et al. Efficacy and safety of therapeutic ERCP for the elderly with choledocholithiasis: comparison with younger patients. Intern Med 2010;49:1935-41.
• 27-Nishikawa T, Tsuyuguchi T, Sakai Y, et al. Old age is associated with increased severity of complications in endoscopic biliary stone removal. Dig Endosc 2014;26:569-76.
• 28-Pang YY, Chun YA. Predictors for emergency biliary decom¬pression in acute cholangitis. Eur J Gastroenterol Hepatol 2006;18:727-31.
• 29-Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest En¬dosc 1991;37:383-93.
• 30-Garcia CJ, Lopez OA, Islam S, et al. Endoscopic retrograde cholangiopancreatography in the elderly. Am J Med Sci 2016;351:84-90.
• 31-Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc 2000;52:187-91.
• 32-Lee JK, Lee SH, Kang BK, et al. Is it necessary to insert a nasobiliary drainage tube routinely after endoscopic clearance of the common bile duct in patients with choledocholithiasis-induced cholangitis? A prospective, ran¬domized trial. Gastrointest Endosc 2010;71:105-10.
• 33-García-Alonso FJ, de Lucas Gallego M, Bonillo Cambrodón D, et al. Gallstone-related disease in the elderly: is there room for improvement? Dig Dis Sci 2015;60:1770-7.
• 34-Katsinelos P, Paroutogou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older. Gastrointest Endosc 2006;63:417-23.