Biliary tract diseases in the elderly: management and outcomes

Siegel, Jerome H.; Kasmin, Franklin

doi:10.1136/gut.41.4.433

Cited by 152 publications

(98 citation statements)

References 17 publications

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“…Safety of Cholecystectomy in Superelderly Patients (≥ Age 90) surgery procedure performed in elderly patients because the incidence of gallstones and gallstone complications increases with age. 2,4 Unfortunately, elderly patients with gallstone complications are less likely to undergo cholecystectomy than are younger patients. 5 Riall et al 12 showed less than 25% of elderly patients who met criteria for elective cholecystectomy underwent cholecystectomy.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

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Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90)

Irojah¹,

Bell

Grim

et al. 2017

TPJ

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Context: Cholecystectomy is the most common general surgery procedure in patients older than age 65 years. By 2050, it is estimated that 2.0% of the population will be older than age 90 years.Objective: To assess the mortality of cholecystectomy in superelderly patients (≥ age 90 years).Design were open and 791 (78.6%) were laparoscopic. Mortality did not decrease significantly during the study period. The overall mortality was 5.5%, significantly less for the laparoscopic group (3.7% vs 12%, p < 0.001) and for the nonemergent group (4.5% vs 9.5%, p < 0.005). The median length of stay for open cholecystectomy was 9 days compared with 5 days for laparoscopic (p < 0.001); for nonemergent cholecystectomy it was 5 days compared with 7 days for emergent cholecystectomy (p < 0.001).Conclusion: The mortality after cholecystectomy in superelderly patients did not change significantly during the study period. The mortality and morbidity for laparoscopic and elective procedures were significantly lower than for open procedures and for emergent procedures, respectively.

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Section: Original Research and Contributionsmentioning

confidence: 99%

“…2 By age 90 years, greater than 24% of men and 35% of women have gallstones. 3 Complications secondary to gallstones such as cholecystitis, cholangitis, and pancreatitis also increase with age.…”

Section: Introductionmentioning

confidence: 99%

Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90)

Irojah¹,

Bell

Grim

et al. 2017

TPJ

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“…In addition, it is thought that the elderly are susceptible to biliary infection because they are prone to cholestasis due to decreased bile secretion and gallbladder contractility and retrograde infection due to dysfunction of the sphincter of Oddi. Hence, the incidence of CBDS also increases with aging 1 .…”

Section: Discussionmentioning

confidence: 99%

“…This aging of society will likely increase the incidence of age-related diseases. Thus, the need for endoscopic removal of common bile duct stones CBDS in the elderly is likely to increase, because CBDS are more common with aging 1 . Previous reports suggest that the elderly can safely undergo endoscopic procedures [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

Ishii

Kitamura

Yamamiya

et al. 2014

Showa Univ J Med Sci

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: We investigated the safety and utility of endoscopic removal of common bile duct stones CBDS in the elderly. In all, 253 patients with CBDS who underwent endoscopic retrograde cholangiopancreatography ERCP between January 2007 and December 2011 at Showa University Hospital were evaluated retrospectively. The median age of the patients was 75 years ; thus, we divided patients into two groups, those aged ≥ 75 years Group A ; n 134 and those aged 75 years Group B ; n 119 . Patients in Group A had signi cantly higher rates of endoscopic sphincterotomy in palliative ERCP 24.8% vs. 10.7% ; p 0.008 and palliative removal of CBDS 34.8% vs. 20.9% ; p 0.015 than patients in Group B. However, the median dose of unitrazepam was signi cantly lower for patients in Group A than Group B 1 vs. 1.4 mg, respectively ; p 0.001 . The rate of use of pentazocine 18.5% vs. 54.7% ; p 0.001 and scopolamine butylbromide 6.2% vs. 23.9% ; p 0.01 was signi cantly lower in Group A patients, whereas the use of glucagon was significantly higher in this group 43.8 vs. 15.4% ; p 0.001 . There were no signi cant differences in the rate of successful endoscopic removal of CBDS, treatment time, complications, and the recurrence of CBDS between the two groups. Endoscopic removal of CBDS in the elderly is a safe procedure with good outcomes if the appropriate treatment is selected.

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“…The mortality rate is reported to be 1-5% compared with the rate of 4% to 20% reported for open elective and emergency procedures in patients over 70 years old. It can be achieved by two methods: via transcystic or choledochotomy (Martin et al,1983;Hacker et al,1990;Gonzalez et all.,1997;Siegel et al,1997;Verbesey et al,2008).…”

Section: Discussionmentioning

confidence: 99%