Are complications of endoscopic sphincterotomy age related?

Abstract

Background-Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endoscopic sphincterotomy in this age group, relative to that in older patients, is unknown. Aim-To determine whether the development of short term complications following endoscopic sphincterotomy is age related. Patients and methods-A prospective multicentre audit of 958 patients (mean age 73, range 14-97, years) undergoing a total of 1000 endoscopic sphincterotomies. Results-Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41-1.67, p=0.74). Conclusion-Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct. (Gut 1997; 41: 545-548)

Advancing age is not a reason to withhold ERCP

“…However they have certain limitations. Deans et al and Agarwal et al included outcomes in patients as young as 60 years of age [9,10]. In contrast, the mean age in our study was 84.7 years for males and 85.1 years for females.…”

Comparison between emergency and elective endoscopic sphincterotomy in patients with acute cholangitis due to choledocholithiasis: is emergency endoscopic sphincterotomy safe?

“…In general, the rate of patients with a hemorrhagic tendency is higher among older patients than among younger patients. Accordingly, a higher age is a risk factor for post-EST hemorrhage [17]. However, in the present study EBD without EST was conducted as the initial treatment in two patients with a hemorrhagic tendency, and then elective EST was carried out after amelioration of the hemorrhagic tendency.…”

Patients With Mortality After Endoscopic Retrograde Cholangiopancreatography

“…Lack of ETCO2 monitoring is one of the limitations of our study. According to the , chronological age alone isn t a contraindication for ERCP or a risk factor for ERCP-related complications [13]. It has been reported that frequency of failure, hypoxia, and bleeding due to sphincterotomy is increased by advancing age and that clinicians should be more careful foralert to complications in elder individuals [14], although it was shown that ERCP can be safely employed for diagnostic and therapeutic purposes in elder individuals in addition to infants and, children and elder individuals [15][16][17][18].…”