Long-term Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Patients ≥90 Years Old: A Multicenter Retrospective Study

Sugimoto, Shinya; Hattori, Aiji; Maegawa, Yuri; Nakamura, Haruka; Okuda, Naoko; Takeuchi, Toshifumi; Oyamada, Jun; Kamei, Akira; Kawabata, Hiroyuki; Aoki, Masatoshi; Naota, Hiroaki

doi:10.2169/internalmedicine.6478-20

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…ERCP is often thought to be associated with more frequent adverse events (AEs) than other gastrointestinal endoscopic procedures (5). In recent years, ERCP has also been effective and safe in elderly patients ≥65 years of age (6,7). Complication rates and mortality rates in elderly patients were 6.7%-8.1% and 0%-0.2%, respectively (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

et al. 2022

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Background and aimThe number of elderly patients with biliary stones is increasing. Endoscopic retrograde cholangiography (ERCP) is considered to be an effective treatment for biliary stones. Having a sound knowledge of the risk factors can help reduce the incidence and severity of complications for ERCP. Furthermore, limited research has been published on patients aged over 85 years undergoing endoscopic biliary stone removal. This study aims to determine the risk factors that lead to complications of ERCP in patients over 85 years of age.MethodsThis was a single-center retrospective study. We analyzed 156 patients aged ≥ 85 years with biliary stones who underwent their first ERCP at Chinese PLA General Hospital from February 2002 to March 2021. Logistic regression models were employed to identify the independent risk factors for complications.ResultsA total of 13 patients (8.3%) had complications. Thereinto, pancreatitis, cholangitis, bleeding, and other complications occurred in 4 cases (2.6%), 1 cases (0.6%), 4 cases (2.6%), and 4 cases (2.6%), respectively. There was no perforation or death related to ERCP. Independent risk factors for complications were acute biliary pancreatitis (ABP) (P = 0.017) and Charlson Comorbidity Index (CCI) (P = 0.019). Significantly, reasons for incomplete stone removal at once were large stone (>10 mm) (P < 0.001) and higher acute physiology and chronic health evaluation scoring system (APACHE-II) (P = 0.005).ConclusionsERCP was recommended with caution in patients ≥ 85 years of age with ABP or higher CCI undergoing endoscopic biliary stone removal. In patients with ABP without cholangitis or biliary obstruction we recommend against urgent (within 48 h) ERCP. Patients with higher CCI who can tolerate ERCP can undergo rapid ERCP biliary stenting or nasobiliary implantation with later treatment of stones, and patients who cannot tolerate ERCP are treated promptly with PTCD and aggressive conservative treatment.

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Section: Introductionmentioning

confidence: 99%

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

et al. 2022

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“…Some diseases did not show significant differences between the groups stratified by sex; however, there were significant intergroup differences according to age for all diseases, especially in the longevity group (age > 90 years). This age group is considered unique, and individuals of this age have been labelled 'super-seniors' (34,35). However, our findings could be attributed to differences in the sample size between the older inpatients with longevity and the other older groups, with the former group comprising less than half the number of individuals in the latter groups.…”

Section: Discussionmentioning

confidence: 76%

Exploring disease interrelationships in older inpatients: a single-centre, retrospective study

Zhang

et al. 2023

Front. Public Health

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BackgroundComorbidity is a common phenomenon in the older population; it causes a heavy burden on societies and individuals. However, the relevant evidence, especially in the southwestern region of China, is insufficient.ObjectivesWe aimed to examine current comorbidity characteristics as well as correlations among diseases in individuals aged >60 years.DesignRetrospective study.MethodsWe included records of 2,995 inpatients treated at the Gerontological Department of Sichuan Geriatric Hospital from January 2018 to February 2022. The patients were divided into groups according to sex and age. Diseases were categorised based on the International Classification of Diseases and their Chinese names. We calculated the age-adjusted Charlson Comorbidity Index (ACCI), categorised diseases using the China Health and Retirement Longitudinal Study questionnaire, and visualised comorbidity using web graphs and the Apriori algorithm.ResultsThe ACCI was generally high, and it increased with age. There were significant differences in the frequency of all diseases across age groups, especially in individuals aged ≥90 years. The most common comorbid diseases were liver diseases, stomach or other digestive diseases, and hypertension. Strong correlations between the most common digestive diseases and hypertension were observed.ConclusionOur findings provide insights into the current situation regarding comorbidity and the correlations among diseases in the older population. We expect our findings to inform future research directions as well as policies regarding general clinical practice and public health, especially for medical consortiums.

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“…The prognosis may vary depending on the condition's severity, the presence of comorbidities, and the patient's overall health. Close monitoring and follow-up care are often necessary to ensure that patients experience a full recovery and maintain their well-being (13).…”

Section: Discussion Discussionmentioning

confidence: 99%

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

Villegas-Coronado,

Murillo-Espinoza,

Ortiz-Valles

et al. 2023

SGO

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Introduction: Choledocholithiasis, the presence of gallstones within the common bile duct, is a challenging medical condition characterized by disruptions in cholesterol, bilirubin, and bile acid metabolism. Patients with choledocholithiasis present with a spectrum of symptoms, from intermittent upper abdominal pain, nausea, and vomiting to jaundice and more severe complications like pancreatitis.Case report: This case study involves a 63-year-old female who presented at the emergency department with colicky pain, jaundice, and discomfort. An abdominal ultrasound diagnosed choledocholithiasis, leading to an endoscopic retrograde cholangiopancreatography (ERCP). The ERCP procedure was technically challenging, possibly due to the choledocholithiasis of large stones (>1.5 cm). Following the initial ERCP, a follow-up CT scan revealed ongoing bile duct dilation and complications related to the stones, necessitating a second procedure. The reintervention proceeded successfully, and the patient recovered well without complications. Conclusions: While conventional therapies for choledocholithiasis, such as ERCP and surgical exploration, demonstrate remarkable success, the reappearance of common bile duct stones raises apprehensions. The need for reintervention could be attributed to elements like anatomical complexities during the initial treatment and stone characteristics. Elevating the outcomes and diminishing the necessity for re-interventions hinges upon the refinement of patient selection, preoperative evaluations, and the implementation of a multidisciplinary approach.

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Long-term Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Patients ≥90 Years Old: A Multicenter Retrospective Study

Cited by 5 publications

References 22 publications

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal

Exploring disease interrelationships in older inpatients: a single-centre, retrospective study

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

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