Reappraisal of safety of endoscopic sphincterotomy for common bile duct stones in the elderly

Deenitchin, Georgi P.; Konomi, Hiroyuki; Kimura, Hiroshi; Ogawa, Yoshiaki; Naritomi, Gen; Chijiiwa, Kazuo; Tanaka, Masao; Ikeda, Seiyo

doi:10.1016/s0002-9610(99)80251-7

Cited by 19 publications

(10 citation statements)

References 15 publications

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“…Logistic regression analysis has shown that the presence of PAD is an independent variable that predicts bleeding after sphincterotomy 67 , but most authors do not feel that bleeding occurs more often in these patients than in the general population 1,23,66,68 . Although some authors still consider IDP to be a relative contraindication to precut or endoscopic sphincterotomy 23 , most large studies have not documented an increased risk of perforation of the diverticulum 1,66,68,69 .…”

Section: Problems With Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 99%

Periampullary diverticula and pancreaticobiliary disease

Lobo

Balfour

Iftikhar

et al. 1999

Journal of British Surgery

135

105

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Section: Problems With Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 99%

Periampullary diverticula and pancreaticobiliary disease

Lobo

Balfour

Iftikhar

et al. 1999

Journal of British Surgery

135

105

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“…13,14 In patients with mild acute pancreatitis 11 or cholangitis 1 , however, the early clearance of CBD stones is necessary to avoid infection (cholecystitis and cholangitis) that may occur after endoscopic investigations. 7,15 At present, the clearance rate of stones can be increased by endoscopic lithotripsy, 15 whereas the complete clearance of multiple or large calculi remains unpredictable. 7 The rate of retained stones after ST was 6% in our series.…”

Section: Retained Stonesmentioning

confidence: 99%

Surgery vs Endoscopy as Primary Treatment in Symptomatic Patients With Suspected Common Bile Duct Stones<subtitle>A Multicenter Randomized Trial</subtitle>

Suc

Escat²,

Cherqui³

et al. 1998

Arch Surg

135

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To compare surgical treatment (ST) with endoscopic management (EM) in patients with suspected common bile duct stones. Patients: Two hundred twenty eligible patients originating from 18 surgery units. Patients enrolled in this multicenter randomized study had clinical symptoms that included jaundice, mild pancreatitis (Ranson score Յ2), or mild acute cholangitis; biliary colic (with increased alkaline phosphatase levels); and common bile duct stones or a common bile duct diameter of 1 cm or larger on ultrasonography. Methods: Two hundred two patients were randomly assigned to either ST (n = 105) or EM (n = 97) during a 5-year period. Both groups were comparable with respect to age, sex, American Society of Anesthesiologists score, and clinical presentation. Main Outcome Measures: The rates of early postoperative additional procedures necessary to deal with the impossibility to perform the initial procedure, complications, and retained stones after ST or EM. Subsidiary endpoints were intention-to-treat analyses of mortality and of major complications and the duration of hospital stay. Results: Surgical treatment was associated with a significantly (PϽ.001) lower rate of 1 or 2 additional procedures (8% vs 29%) due to a significantly lower rate of the impossibility to perform the initial procedure (0% vs 5%) (PϽ.05), major complications (4% vs 13%) (PϽ.05), and retained stones (6% vs 16%) (PϽ.04). Minor complications occurred more often in patients having ST (4%) than in those having EM (0%) (PϽ.01). Cholecystectomy was performed routinely in 102 patients having ST and electively in 36 patients having EM. There was 1 death in each group initially. On an intention-to-treat analysis, 3 deaths (3.1%) occurred after EM and 1 (0.9%) after ST; this difference was not statistically significant (P = .56). Major complications occurred in 4% of patients having ST compared with 11% of patients having EM (PϽ.002). The median duration of hospital stay was 16 days in patients having ST and 12 days in those having EM; this difference was not statistically significant (P = .09).

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“…The management of acute cholangitis in the elderly commonly becomes difficult due to a higher incidence of coexisting cardiovascular, pulmonary, neurologic, and other systemic diseases. 16 Studies have shown that the success rates of therapeutic ERCP are similar between elderly and young patients although the morbidity and mortality associated with therapeutic ERCP are greater in the elderly than in young patients. 17 The presentation of several patients treated with antibiotics alone was misattributed to ischemic hepatitis, urinary tract sepsis, or pneumonia before considering acute cholangitis as the primary reason for the patient's demise.…”

Section: Discussionmentioning

confidence: 99%