Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

“…Adverse events occur in 5–18% of patients treated with this procedure [ 15 , 20 , 22 , 44 ], and the incidence rate was 5% in the present study. In contrast to conventional ERCP, perforation is one of the most common adverse events for this procedure [ 45 ] and occurs mainly during scope insertion or stone extraction.…”

“…In addition, patients enrolled in this study were relatively elderly, showing a median age of 79 years old. A previous study also reported that both technical success rates and the rates of adverse events were similar between elderly (≥75 years old) and non-elderly groups (<75 years old), suggesting that BE-ERCP is a feasible procedure for elderly individuals with a surgically altered anatomy [ 44 ]. Repeated BE-ERCP may carry a risk for elderly patients, so middle-term stent placement may be an option for the treatment of cases of complicated CBD stones, although caution against life-threatening cholangitis should be practiced [ 4 , 47 ].…”

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

“…The initial literature search resulted in 4105 studies, with 76 of them [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ,…”

Biliopancreatic Endoscopy in Altered Anatomy

“…These techniques have showed different success rates over the years, depending mostly on the surgical alterations. Overall, sDBE-ERCP had a success rate between 70.7 and 96% [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ], while SBE-ERCP appeared to be as effective as sDBE, with a success rate among 73 and 92.3% [ 36 , 37 , 38 , 39 ]. Among studies about SBE-ERCP, Lenze et al [ 40 ] in a prospective single-center study, showed a lower success rate (57.7%), but they also found in univariate analysis that malignant biliary obstruction had a significantly higher risk of SBE-ERCP failure (OR = 11.33, p = 0.001).…”