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Takahashi K, Ohyama H, Takiguchi Y, Sekine Y, Toyama S, Yamada N, Sugihara C, Kan M, Ouchi M, Nagashima H, Iino Y, Kusakabe Y, Okitsu K, Ohno I, Kato N. Safety of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid mass in the elderly: A single-center retrospective study. Geriatr Gerontol Int 2023; 23:836-841. [PMID: 37752034 DOI: 10.1111/ggi.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
AIM There are few reports on the safety of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the elderly. In this study, we investigated the safety of EUS-FNA for pancreatic solid masses in patients aged ≥80 years. METHODS This is a single-center retrospective study. A total of 600 patients with pancreatic solid masses who underwent EUS-FNA under midazolam-based sedation at our institution between September 2016 and December 2022 were enrolled in this study. Eligible patients were divided into two groups: an elderly group aged ≥80 (n = 84), as well as a nonelderly group aged ≤79 (n = 516). These two groups were compared. RESULTS The elderly group required significantly fewer midazolam doses for sedation (P < 0.001). Adverse events occurred in eight patients (1.3%), including one (1.2%) and seven (1.4%) in the elderly and nonelderly groups, respectively (P = 0.90). There were no cases of early adverse events in the elderly group and six cases (1.2%) in the nonelderly group (P = 0.32). There was one case of late adverse events in both the elderly and nonelderly groups (P = 0.14), and both were needle tract seeding. There was no significant difference between the two groups in the proportion of cases in which percutaneous oxygen saturation decreased to ≤90% during the EUS-FNA. CONCLUSIONS Our analysis suggests that EUS-FNA for pancreatic solid masses can be safely performed in patients aged >80 years without increasing the adverse event rate compared to nonelderly patients aged <80 years. Geriatr Gerontol Int 2023; 23: 836-841.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yu Sekine
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shodai Toyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nana Yamada
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Chihei Sugihara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Motoyasu Kan
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mayu Ouchi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yotaro Iino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuko Kusakabe
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohichiroh Okitsu
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Takahashi K, Ohyama H, Mikata R, Nagashima H, Ohno I, Takiguchi Y, Kato N. Intraperitoneal bleeding from the right gastroepiploic artery by endoscopic ultrasonography: a case report. J Rural Med 2022; 17:184-188. [PMID: 35847751 PMCID: PMC9263947 DOI: 10.2185/jrm.2022-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: To describe the case of a patient with intraperitoneal bleeding
from the gastroepiploic artery by endoscopic ultrasound who was successfully treated with
transcatheter arterial coil embolization. Patient and Methods: An 87-year-old man was referred to our hospital for
examination of a gallbladder tumor. Endoscopic ultrasonography was performed using an
oblique-view echoendoscope. After the endoscopic ultrasound, the patient went into shock.
Computed tomography revealed a huge intraperitoneal hematoma and an aneurysm in the right
gastroepiploic artery that were not seen on previous computed tomography images. Thus,
urgent catheter angiography was performed, which showed a pseudoaneurysm of the right
gastroepiploic artery and extravasation of the contrast medium from the
pseudoaneurysm. Results: Transcatheter arterial coil embolization was subsequently
performed, and the bleeding stopped. Thereafter, his hemodynamics stabilized and his
general condition improved. The patient was discharged 22 days post-treatment with an
uneventful course. Conclusion: Observation-only endoscopic ultrasound without invasive
procedures can cause intraperitoneal bleeding due to a ruptured splanchnic artery. Thus,
endoscopic ultrasonography should be performed more carefully in elderly patients.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Rintaro Mikata
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
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Lin YJ, Wang YC, Huang HH, Huang CH, Liao MX, Lin PL. Target-controlled propofol infusion with or without bispectral index monitoring of sedation during advanced gastrointestinal endoscopy. J Gastroenterol Hepatol 2020; 35:1189-1195. [PMID: 31802534 DOI: 10.1111/jgh.14943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Target-controlled infusion (TCI) uses averaged pharmacokinetic datasets derived from population samples to automatically control the infusion rate. Bispectral index (BIS) technology non-invasively measures levels of consciousness during surgical procedures. We compared the efficacy and safety of propofol TCI with or without BIS monitoring for sedation during advanced gastrointestinal endoscopy. METHODS This prospective study enrolled 200 patients who were premedicated with midazolam 2 mg and alfentanil 0.4 mg before undergoing advanced gastrointestinal endoscopy. The initial target blood concentration of propofol was set at 1.0 μg/mL, and adjustments of 0.2 μg/mL were made as necessary to maintain moderate-to-deep sedation. Patients were randomized to either the BIS-blind group and evaluated for depth of anesthesia by monitoring scores of 1-2 on the Modified Observer's Assessment of Alertness/Sedation scale (n = 100) or to the BIS-open group and monitored by BIS scores of 60-80 (n = 100). The primary outcome was the total amount of propofol required to maintain anesthesia. Secondary outcomes were sedation-induced adverse events, recovery, and quality of sedation (endoscopist and patient satisfaction). RESULTS The mean propofol infusion rate was significantly higher in patients not monitored by BIS scores than in those who were (5.44 ± 2.12 vs 4.76 ± 1.84 mg/kg/h; P = 0.016). Levels of satisfaction were higher for endoscopists who used BIS monitoring than in those who did not. CONCLUSIONS Mean infusion rates were higher in propofol TCI without BIS monitoring compared with propofol TCI with BIS during advanced gastrointestinal endoscopy. Endoscopists expressed satisfaction with BIS monitoring.
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Affiliation(s)
- Yueh-Juh Lin
- Department of Cardiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Xiu Liao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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El bacha H, Prat F. Endoscopic management of iatrogenic EUS-related duodenal perforations with over-the-scope clips. Endosc Int Open 2020; 8:E59-E63. [PMID: 31921985 PMCID: PMC6949172 DOI: 10.1055/a-0967-4718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Iatrogenic endoscopic ultrasound (EUS) perforations are life-threatening adverse event and to date, surgery has been the main treatment for them. The aim of this study was to assess feasibility and safety of conservative treatment with over-the-scope clips (OTSC). Patients and methods We performed a retrospective study, including iatrogenic EUS duodenal perforation with conservative endoscopic management from 2011 to August 2018. Patients who initial had surgical management were excluded. Results In 8504 EUS procedure occurred, 13 perforations occurred (0.15 %). Eleven patients were included in the study, all women. Mean patient age was 75 years (range 68 - 88). Eighth of 11 perforations (72.7 %) were due to a radial probe and three of 11 (27.3 %) were due to a curvilinear probe. Eleven procedures (100 %) were performed as diagnostic. Defect size ranged from 10 to 15 mm. All procedures were successful. Three of eleven patients (27 %) had a stay in intensive care unit for less than 72 hours and length of total hospital stay ranged from 3 to 22 days. Conclusion Conservative endoscopic treatment of Iatrogenic EUS perforation, with OTSC is feasible, efficient and safe.
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Affiliation(s)
- Hicham El bacha
- Medecine B, Hôpital ibn-sina, Mohamed V University, Rabat, Morocco,Corresponding author Hicham El Bacha Rue Ait Mhammed SouissiRabatMaroc+05 37 77 58 56
| | - Frederic Prat
- Gastroenterology Department, Hôpital Cochin, Paris, France
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Yu CY, Chien CH, Hsieh PJ, Chien RN. Cervical esophageal perforation during endoscopic ultrasonography: A retrospective evaluation of frequency, outcome, and patient management. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Chia-Ying Yu
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
| | - Cheng-Hung Chien
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
| | - Po-Jen Hsieh
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
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García García de Paredes A, Mateos Muñoz B, Albillos A. [Gastrointestinal endoscopy in patients of advanced age]. Rev Esp Geriatr Gerontol 2018; 53:293-298. [PMID: 29598971 DOI: 10.1016/j.regg.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
Abstract
The dramatic increase in life expectancy is leading to a significant increase in the use of gastrointestinal endoscopy in the elderly. Taking into account these demographic changes, the use of gastrointestinal endoscopy in this age group is of great importance. Although these procedures are generally safe and well tolerated even in very elderly patients, the onset of physiological changes associated with aging and the increased prevalence of cardiovascular and pulmonary comorbidities raise the risk of sedation related complications in these patients. Age alone is not a contraindication for performing any endoscopic procedure. However, elderly patients have their own peculiarities that require a detailed review of the characteristics, risks and benefits of endoscopic procedures in this specific context.
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Affiliation(s)
- Ana García García de Paredes
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - Beatriz Mateos Muñoz
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - Agustín Albillos
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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Lin HH, Chang CW, Wu PS, Chu CH, Shih SC, Chen MJ. The Application of EUS-guided FNA in the Diagnosis of Pancreatic Neoplasms in the Elderly. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Miyanaga R, Hosoe N, Naganuma M, Hirata K, Fukuhara S, Nakazato Y, Ojiro K, Iwasaki E, Yahagi N, Ogata H, Kanai T. Complications and outcomes of routine endoscopy in the very elderly. Endosc Int Open 2018; 6:E224-E229. [PMID: 29423432 PMCID: PMC5802997 DOI: 10.1055/s-0043-120569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/17/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND STUDY AIMS In Japan, the elderly population has been increasing annually. The number of elderly patients for whom esophagogastroduodenoscopy (EGD) and colonoscopy (CS) is indicated also has been rising. The aim of this study was to evaluate the safety and efficacy of routine endoscopy in a cohort of octogenarians aged 85 years and older - defined by the World Health Organization as the very elderly. PATIENTS AND METHODS A total of 5,586 patients underwent EGDs, and 2,484 patients underwent CSs performed at the Keio University Hospital from January to September 2014. One hundred eighty-five EGDs and 70 of the CS were performed in the very elderly. Six hundred nine EGDs and 262 CS were performed on younger patients (aged forties). Statistical analysis was performed by univariate and multivariate analyses. RESULTS On univariate analysis, the rate of adverse events (AEs) in the very elderly was significantly higher compared to the younger group (6.3 % vs. 1.1 %; P < 0.01). Moreover, the very elderly cohort received substantial therapeutic intervention as compared to the younger (16.9 % vs. 6.9 %; P < 0.01). On multivariate analysis, independent risk factors of AEs included: very elderly patients (odds ratio (OR) 3.30, 95 % confidence interval (CI) 1.05 - 10.35), inpatients (OR 3.22, 95 % CI 1.34 - 7.74), and use of pethidine hydrochloride prescription (OR 3.44, 95 % CI 1.51 - 7.81). CONCLUSIONS Routine endoscopy in the very elderly incurs a significant risk of AEs, particularly when combined with pethidine hydrochloride prescription.
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Affiliation(s)
- Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Yoshihiro Nakazato
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Keisuke Ojiro
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan.
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.,Corresponding author Takanori Kanai, MD, PhD Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of Medicine, Keio University35 ShinanomachiShinjuku, Tokyo 160-8582, Japan+81-3-3357-2778
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Best LMJ, Rawji V, Pereira SP, Davidson BR, Gurusamy KS. Imaging modalities for characterising focal pancreatic lesions. Cochrane Database Syst Rev 2017; 4:CD010213. [PMID: 28415140 PMCID: PMC6478242 DOI: 10.1002/14651858.cd010213.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of focal pancreatic lesions. OBJECTIVES To determine and compare the diagnostic accuracy of various imaging modalities in detecting cancerous and precancerous lesions in people with focal pancreatic lesions. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, and Science Citation Index until 19 July 2016. We searched the references of included studies to identify further studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We planned to include studies reporting cross-sectional information on the index test (CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), EUS (endoscopic ultrasound), EUS elastography, and EUS-guided biopsy or FNA (fine-needle aspiration)) and reference standard (confirmation of the nature of the lesion was obtained by histopathological examination of the entire lesion by surgical excision, or histopathological examination for confirmation of precancer or cancer by biopsy and clinical follow-up of at least six months in people with negative index tests) in people with pancreatic lesions irrespective of language or publication status or whether the data were collected prospectively or retrospectively. DATA COLLECTION AND ANALYSIS Two review authors independently searched the references to identify relevant studies and extracted the data. We planned to use the bivariate analysis to calculate the summary sensitivity and specificity with their 95% confidence intervals and the hierarchical summary receiver operating characteristic (HSROC) to compare the tests and assess heterogeneity, but used simpler models (such as univariate random-effects model and univariate fixed-effect model) for combining studies when appropriate because of the sparse data. We were unable to compare the diagnostic performance of the tests using formal statistical methods because of sparse data. MAIN RESULTS We included 54 studies involving a total of 3,196 participants evaluating the diagnostic accuracy of various index tests. In these 54 studies, eight different target conditions were identified with different final diagnoses constituting benign, precancerous, and cancerous lesions. None of the studies was of high methodological quality. None of the comparisons in which single studies were included was of sufficiently high methodological quality to warrant highlighting of the results. For differentiation of cancerous lesions from benign or precancerous lesions, we identified only one study per index test. The second analysis, of studies differentiating cancerous versus benign lesions, provided three tests in which meta-analysis could be performed. The sensitivities and specificities for diagnosing cancer were: EUS-FNA: sensitivity 0.79 (95% confidence interval (CI) 0.07 to 1.00), specificity 1.00 (95% CI 0.91 to 1.00); EUS: sensitivity 0.95 (95% CI 0.84 to 0.99), specificity 0.53 (95% CI 0.31 to 0.74); PET: sensitivity 0.92 (95% CI 0.80 to 0.97), specificity 0.65 (95% CI 0.39 to 0.84). The third analysis, of studies differentiating precancerous or cancerous lesions from benign lesions, only provided one test (EUS-FNA) in which meta-analysis was performed. EUS-FNA had moderate sensitivity for diagnosing precancerous or cancerous lesions (sensitivity 0.73 (95% CI 0.01 to 1.00) and high specificity 0.94 (95% CI 0.15 to 1.00), the extremely wide confidence intervals reflecting the heterogeneity between the studies). The fourth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (dysplasia) provided three tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing invasive carcinoma were: CT: sensitivity 0.72 (95% CI 0.50 to 0.87), specificity 0.92 (95% CI 0.81 to 0.97); EUS: sensitivity 0.78 (95% CI 0.44 to 0.94), specificity 0.91 (95% CI 0.61 to 0.98); EUS-FNA: sensitivity 0.66 (95% CI 0.03 to 0.99), specificity 0.92 (95% CI 0.73 to 0.98). The fifth analysis, of studies differentiating cancerous (high-grade dysplasia or invasive carcinoma) versus precancerous (low- or intermediate-grade dysplasia) provided six tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing cancer (high-grade dysplasia or invasive carcinoma) were: CT: sensitivity 0.87 (95% CI 0.00 to 1.00), specificity 0.96 (95% CI 0.00 to 1.00); EUS: sensitivity 0.86 (95% CI 0.74 to 0.92), specificity 0.91 (95% CI 0.83 to 0.96); EUS-FNA: sensitivity 0.47 (95% CI 0.24 to 0.70), specificity 0.91 (95% CI 0.32 to 1.00); EUS-FNA carcinoembryonic antigen 200 ng/mL: sensitivity 0.58 (95% CI 0.28 to 0.83), specificity 0.51 (95% CI 0.19 to 0.81); MRI: sensitivity 0.69 (95% CI 0.44 to 0.86), specificity 0.93 (95% CI 0.43 to 1.00); PET: sensitivity 0.90 (95% CI 0.79 to 0.96), specificity 0.94 (95% CI 0.81 to 0.99). The sixth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (low-grade dysplasia) provided no tests in which meta-analysis was performed. The seventh analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) provided two tests in which meta-analysis was performed. The sensitivity and specificity for diagnosing cancer were: CT: sensitivity 0.83 (95% CI 0.68 to 0.92), specificity 0.83 (95% CI 0.64 to 0.93) and MRI: sensitivity 0.80 (95% CI 0.58 to 0.92), specificity 0.81 (95% CI 0.53 to 0.95), respectively. The eighth analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) or benign lesions provided no test in which meta-analysis was performed.There were no major alterations in the subgroup analysis of cystic pancreatic focal lesions (42 studies; 2086 participants). None of the included studies evaluated EUS elastography or sequential testing. AUTHORS' CONCLUSIONS We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons.
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Affiliation(s)
- Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
| | - Vishal Rawji
- University College London Medical SchoolLondonUK
| | - Stephen P Pereira
- Royal Free Hospital CampusUCL Institute for Liver and Digestive HealthUpper 3rd FloorLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
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Park TY, Choi JS, Oh HC, Kim JW, Do JH, Jung YH. Assessment of safety of non-anesthesiologist-assisted endoscopic retrograde cholangiopancreatography based on performance status in elderly patients. J Gastroenterol Hepatol 2014; 29:1943-8. [PMID: 24730577 DOI: 10.1111/jgh.12608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in the elderly patients, yet little is known concerning objective criteria of safety. This study aimed to determine the potential predictors for the procedure-related outcomes. METHODS Two hundred eighty-one patients older than 70 years who were indicated for ERCP (group A [n = 195], 70-79 years of age; group B [n = 86], ≥ 80 years of age) were prospectively enrolled and analyzed for the development of serious adverse events related to ERCP. RESULTS ERCP was not performed in six patients at high risk for the procedure. There were significant differences between group A and B in Duke Activity Status Index (DASI) (23.1 vs 14.9, P < 0.01) and Eastern Cooperative Oncology Group performance status (3 and 4, 49/195 vs 33/86, P < 0.05). Major ERCP-related complications (hypotension, severe bradycardia, hypoxia, myocardial infarction, cerebral infarction) occurred in five patients from group B and three from group A. Post-ERCP pancreatitis occurred in one patient from group A and bleeding in one from group B. In univariate analysis, old age (≥ 80 years), American Society of Anesthesiologists score ≥ 3, and DASI < 10 were statistically significant predictors for overall serious events related to ERCP. In the multivariate analysis, DASI < 10 (only manage to ambulate) was independent predictor for overall serious events related to ERCP. CONCLUSION DASI score is useful predictor for the feasibility assessment of safe ERCP in the elderly patients.
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Affiliation(s)
- Tae Young Park
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea
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Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med 2014; 30:133-47. [PMID: 24267608 DOI: 10.1016/j.cger.2013.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There has been limited research examining the risks, benefits, and use of common endoscopic procedures in the elderly. Furthermore, gastroenterology training programs do not routinely incorporate elderly concerns when dealing with common gastrointestinal issues. There exists a broad array of endoscopic procedures with varying inherent risks that must be weighed with each elderly patient in mind. This article discusses the benefits and drawbacks of the most common procedures and indications for endoscopy including upper endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, percutaneous endoscopic gastrostomy, and deep enteroscopy.
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Affiliation(s)
- Farid Razavi
- Division of Gastroenterology, Langone Medical Center, New York University, 550 1st Avenue, New York, NY 10016, USA.
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Buscarini E, Pezzilli R, Cannizzaro R, De Angelis C, Gion M, Morana G, Zamboni G, Arcidiacono P, Balzano G, Barresi L, Basso D, Bocus P, Calculli L, Capurso G, Canzonieri V, Casadei R, Crippa S, D'Onofrio M, Frulloni L, Fusaroli P, Manfredi G, Pacchioni D, Pasquali C, Rocca R, Ventrucci M, Venturini S, Villanacci V, Zerbi A, Falconi M. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014; 46:479-93. [PMID: 24809235 DOI: 10.1016/j.dld.2013.12.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/07/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.
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Affiliation(s)
| | | | | | - Raffaele Pezzilli
- Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Claudio De Angelis
- Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy
| | - Massimo Gion
- Department of Clinical Pathology, AULSS 12, Venice, Italy
| | - Giovanni Morana
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Paolo Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy
| | - Gianpaolo Balzano
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Barresi
- Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - Paolo Bocus
- Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy
| | - Lucia Calculli
- Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy
| | | | - Riccardo Casadei
- Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Crippa
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy
| | - Pietro Fusaroli
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | | | - Claudio Pasquali
- Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Rodolfo Rocca
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Maurizio Ventrucci
- Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy
| | - Silvia Venturini
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Alessandro Zerbi
- Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Falconi
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
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Kurt M, Oguz D, Oztas E, Kalkan IH, Sayilir A, Beyazit Y, Sasmaz N. Safety of endoscopic ultrasonography in elderly patients: a single center prospective trial. Aging Clin Exp Res 2013; 25:571-4. [PMID: 24026626 DOI: 10.1007/s40520-013-0138-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 03/27/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS The aim of this prospective study is to evaluate the safety of both diagnostic and therapeutic endosonography (EUS) in geriatric population. METHODS The study population, consisting of 222 patients who underwent endosonographic evaluation for different indications, was divided into two groups. Group I consisted of 165 patients, ≥ 65 years old; Group II consisted of 57 controls, <65 years old. The demographic information with clinical parameters, procedure medication used and complications was noted. RESULTS The median age of Group I was 72 years (range 65-93 years) vs. 46 years (range 26-64 years) for Group II. Female-to-male ratio was 82/83 in Group I, while 32/25 in Group II. Pulse rate (84 vs. 89 beats/min, p = 0.024) and basal oxygen saturation (94 vs. 97 %, p < 0.001) levels were lower in Group I when compared with the control group, while systolic blood pressure measurements (150 vs. 130 mmHg, p < 0.001) were significantly higher in Group I. No cases of procedure-related bleeding, perforation and mortality were observed in both groups. CONCLUSION Despite the well-known relative increased procedural risks, advanced age is not a contraindication for advanced endoscopic interventions. EUS can be regarded as a safe and effective procedure in ≥ 65 years old population.
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Affiliation(s)
- Mevlut Kurt
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Kizilay Sok. No:4, Sihhiye, Ankara, Turkey
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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Abstract
With increasing age, the incidence of both benign and malignant gastrointestinal (GI) disease rises. Endoscopic procedures are commonly performed in elderly and very elderly patients to diagnose and treat GI disorders. There are a number of issues to contemplate when considering performing an endoscopic procedure in an elderly patient, including the anticipated benefits of endoscopy as well as the increased risks associated with procedural sedation and some endoscopic procedures. This review will focus on the yield and safety of endoscopic procedures in older adults.
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Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
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Combined ERCP and EUS in one session is safe in elderly patients when compared to non-elderly patients: outcomes in 206 combined procedures. Dig Dis Sci 2012; 57:1949-53. [PMID: 22453997 DOI: 10.1007/s10620-012-2135-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 03/02/2012] [Indexed: 12/30/2022]
Abstract
AIMS Combined ERCP/EUS is becoming common. Combined procedures are frequently performed in elderly patients. We hypothesized that combined ERCP/EUS is equally safe in elderly patients when compared to non-elderly patients. METHODS This was a retrospective single-center study comparing outcomes in elderly and non-elderly patients undergoing combined ERCP/EUS. RESULTS A total of 206 patients were included. Mean age was 65 years (M:F 113:93); 99 were <65 years and 107 were >65. Indications included: jaundice (51%), abnormal imaging (17%), pancreatic tumor (11%), abdominal pain (5%), stent placement/change (5%), acute or chronic pancreatitis (5%), other (6%). Fine needle aspiration was performed in 134 (65%) procedures. Malignancy was identified in 142/206 (69%) patients. Mean Charlson Comorbidity Index (CCI) was 7.5 (range 0-22). Among patients <65 years old there were no immediate adverse events. Long-term adverse events in patients <65 (within 30 days) included cholangitis (1), increasing abdominal pain (4), post-ERCP pancreatitis (3), nausea/vomiting (1), increasing fatigue (1), and increasing jaundice (1). A subgroup analysis among geriatric patients (>65) was performed. Mean CCI was 8.2 (range 0-22). There was one immediate adverse event of non-sustained ventricular tachycardia in a 76-year old. Long-term adverse events included increasing fatigue (1), nausea/vomiting (2), increasing abdominal pain (2), urosepsis (1), fever (2) and dehydration (1). There were no statistically significant differences in outcomes in elderly compared to non-elderly patients. Elderly patients had higher CCI scores (p = 0.04). CONCLUSION Combined ERCP/EUS in one session is safe in the general population and elderly patients, with no more adverse events than in non-elderly patients.
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Amornyotin S, Leelakusolvong S, Chalayonnawin W, Kongphlay S. Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country. Clin Exp Gastroenterol 2012; 5:123-8. [PMID: 22826640 PMCID: PMC3401056 DOI: 10.2147/ceg.s31275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures in elderly patients are on the rise, and they play an important role in the diagnosis and management of various gastrointestinal diseases. The use of deep sedation in these patients has been established as a safe and effective technique in Western countries; however, it is uncertain if the situation holds true among Asians. The present study aimed to evaluate the age-dependent safety analysis and clinical efficacy of propofol-based deep sedation (PBDS) for ERCP and EUS procedures in adult patients at a World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. METHODS We undertook a retrospective review of anesthesia or sedation service records of patients who underwent ERCP and EUS procedures. All procedures were performed by staff endoscopists, and all sedations were administered by anesthesia personnel in the endoscopy room. RESULTS PBDS was provided for 491 ERCP and EUS procedures. Of these, 252 patients (mean age, 45.1 + 11.1 years, range 17-65 years) were in the <65 age group, 209 patients (mean age, 71.7 + 4.3 years, range 65-80 years) were in the 65-80 year-old group, and 30 patients (mean age, 84.6 + 4.2 years, range 81-97 years) were in the >80 age group. Common indications for the procedures were pancreatic tumor, cholelithiasis, and gastric tumor. Fentanyl, propofol, and midazolam were the most common sedative drugs used in all three groups. The mean doses of propofol and midazolam in the very old patients were relatively lower than in the other groups. The combination of propofol, midazolam, and fentanyl, as well as propofol and fentanyl, were frequently used in all patients. Sedation-related adverse events and procedure-related complications were not statistically significantly different among the three groups. Hypotension was the most common complication. CONCLUSION In the setting of the WGO Endoscopy Training Center in a developing country, PBDS for ERCP and EUS procedures in elderly patients by trained anesthesia personnel with appropriate monitoring is relatively safe and effective. Although adverse cardiovascular events, including hypotension, in this aged group is common, all adverse events were usually transient, mild, and easily treated, with no sequelae.
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Affiliation(s)
- Somchai Amornyotin
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Leelakusolvong
- Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Somchai Amornyotin, Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand, Tel +66 2419 7990, Fax +66 2411 3256, Email
| | - Wiyada Chalayonnawin
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siriporn Kongphlay
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Steed H. Endoscopic retrograde cholangiopancreatography in nonagenarians: a decades-long experience in a single center. J Am Geriatr Soc 2011; 59:2387-8. [PMID: 22188091 DOI: 10.1111/j.1532-5415.2011.03704.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cho DH, Park GT, Oh JE, Chung CW, Yoo GJ, Kim SR, Shim SG. [A single institution's experience of endoscopic retrograde cholangiopancreaticography in the eldery patients: outcomes, safety and complications]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 58:88-92. [PMID: 21873823 DOI: 10.4166/kjg.2011.58.2.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIMS As the population ages, endoscopic retrograde cholangiopancreaticography (ERCP) is being used increasingly as a diagnostic and therapeutic tool for elderly patients with pancreatobiliary disease. The aim of this study was to assess the outcomes, safety and complications associated with ERCP performed in the elderly patients. METHODS We retrospectively reviewed the medical record of 596 patients who were 50 years of age or older and underwent ERCP from January 2005 to September 2010. The patients were classified into two groups according to the age: non-elderly, 50-74 years old and elderly, ≥75 years old. Comparisons were made between two groups. RESULTS Five hundred and ninety-six patients (132 elderly and 464 non-elderly patients) were enrolled. The success rate of ERCP was 89.4% in the elderly and 91.9% in the non-elderly. The major complications were occurred in 11 patients of the elderly and 16 of the non-elderly, and the complication rate was significantly higher in the elderly compared to the non-elderly (8.3% vs. 3.4%, p=0.011). Pancreatitis occurred in 2 elderly patients and 10 non-elderly patients (1.5% vs. 2.1%, p=1.0). There was a higher rate of bleeding in the elderly patients (4.5% vs. 1.3%, p=0.01). CONCLUSIONS ERCP is effective and safe even in elderly patients. Outcomes of diagnostic and therapeutic ERCP in the elderly patients were similar to those in non-elderly patients. Elderly patients undergoing ERCP carried similar risk of pancreatitis but a higher risk of bleeding and perforation compared to non-elderly patients.
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Affiliation(s)
- Dae Hyeon Cho
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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