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Gardenyes J, Roura P, Vallverdú-Cartie H, Hermoso-Bosch J, Roca C, Espaulella M, Casals A, Marani HI, Saló J, Galdín M, Gallach M, Leal C. Endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis in older patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:244-249. [PMID: 38031917 DOI: 10.17235/reed.2023.10051/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND older adults are increasing in number and frequently seek hospital care for acute illness. This study aimed to measure the utilization and safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients aged 85 and older in our hospital. METHODS a single-site, retrospective, observational and descriptive study was performed. Data about admissions and ERCP utilization was obtained from our hospital database. Medical and procedural records of patients aged 85 or older who underwent ERCP for choledocholithiasis between 2013 and 2019 were reviewed. Technical and medical adverse events after ERCP were evaluated. RESULTS four hundred and ninety-four ERCP due to choledocholithiasis were performed during the study period and 154 (31 %) patients were aged 85 or older; 567 (4.8 %) admissions due to biliary tract diseases were identified in the older population, and 27 % of cases required ERCP. In older patients, the rate of technical adverse events was around 10 %. There was no statistical difference between the older and younger groups regarding technical complications (8.8 vs 9.7 %; p = 0.7). Furthermore, in 36 % of cases, a medical event, decompensated comorbidity or geriatric syndromes appeared after ERCP. The overall mortality for any cause at six months was nearly 20 %, and the survival rate was significantly lower in patients who developed adverse events (technical or medical). CONCLUSIONS in our hospital, ERCP is frequently used for patients aged 85 and older. Although technical adverse event rates are similar to those of younger adults, medical events appear frequently. We plan to strengthen our care plans for older adults and hope to reduce the medical complications experienced post-ERCP.
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Affiliation(s)
- Júlia Gardenyes
- General Surgery , Fundació Hospital d'Olot i Comarcal de la Garrotxa, Spain
| | - Pere Roura
- Epidemiology , Hospital Universitari de Vic-Consorci Hospitalari de Vic
| | | | - Judit Hermoso-Bosch
- General Surgery , Hospital Universitari de Vic - Consorci Hospitalari de Vic
| | - Clàudia Roca
- Geriatrics, Hospital Universitari de Vic - Consorci Hospitalari de Vic
| | | | - Antoni Casals
- Geriatrics , Hospital Universitari de Vic - Consorci Hospitalari de Vic
| | - Héctor Ivo Marani
- General Surgery , Fundació Hospital d'Olot i Comarcal de la Garrotxa
| | - Joan Saló
- Gastroenterology, Hospital Universitari de Vic - Consorci Hospitalari de Vic
| | - Martín Galdín
- Gastroenterology , Hospital Universitari de Vic - Consorci Hospitalari de Vic
| | - Marta Gallach
- Gastroenterology , Hospital Universitari de Vic - Consorci Hospitalari de Vic
| | - Carles Leal
- Gastroenterology , Hospital Universitari de Vic - Consorci Hospitalari de Vic
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Basida SD, Dahiya DS, Yousaf MN, Basida B, Pinnam BSM, Gangwani MK, Ali H, Singh S, Shah YR, Ahluwalia D, Shah MP, Chandan S, Sharma NR, Thakkar S. Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians: A United States national experience. World J Gastrointest Endosc 2024; 16:148-156. [PMID: 38577647 PMCID: PMC10989256 DOI: 10.4253/wjge.v16.i3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/19/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an essential therapeutic tool for biliary and pancreatic diseases. Frail and elderly patients, especially those aged ≥ 90 years are generally considered a higher-risk population for ERCP-related complications.
AIM To investigate outcomes of ERCP in the Non-agenarian population (≥ 90 years) concerning Frailty.
METHODS This is a cohort study using the 2018-2020 National Readmission Database. Patients aged ≥ 90 were identified who underwent ERCP, using the international classification of diseases-10 code with clinical modification. Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail. The primary outcome was mortality, and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP. We used univariate and multivariate regression models for analysis.
RESULTS A total of 9448 patients were admitted for any indications of ERCP. Frail and non-frail patients were 3445 (36.46%) and 6003 (63.53%) respectively. Indications for ERCP were Choledocholithiasis (74.84%), Biliary pancreatitis (9.19%), Pancreatico-biliary cancer (7.6%), Biliary stricture (4.84%), and Cholangitis (1.51%). Mortality rates were higher in frail group [adjusted odds ratio (aOR) = 1.68, P = 0.02]. The Intra-procedural complications were insignificant between the two groups which included bleeding (aOR = 0.72, P = 0.67), accidental punctures/lacerations (aOR = 0.77, P = 0.5), and mechanical ventilation rates (aOR = 1.19, P = 0.6). Post-ERCP complication rate was similar for bleeding (aOR = 0.72, P = 0.41) and post-ERCP pancreatitis (aOR = 1.4, P = 0.44). Frail patients had a longer length of stay (6.7 d vs 5.5 d) and higher mean total charges of hospitalization ($78807 vs $71392) compared to controls (P < 0.001). The 30 d all-cause readmission rates between frail and non-frail patients were similar (P = 0.96).
CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail. Larger studies are warranted to investigate and mitigate modifiable risk factors.
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Affiliation(s)
- Sanket Dhirubhai Basida
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65212, United States
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
| | - Muhammad Nadeem Yousaf
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| | - Brinda Basida
- Department of Rheumatology, Medical College of Georgia, Augusta University, North Augusta, GA 30912, United States
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
| | - Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
| | - Yash R Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
| | - Daksh Ahluwalia
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Mihir Prakash Shah
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States
| | - Neil R Sharma
- Division of Interventional Oncology & Surgical Endoscopy, GI Oncology Tumor Site Team, Parkview Cancer Institute, Parkview Health, Fort Wayne, IN 46845, United States
| | - Shyam Thakkar
- Section of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
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Colmenero Gargari AE, Melgar Somoza FE, Vera J, Micames CG. ERCP in patients over 90 years old: Safety and efficacy comparison with a younger cohort. Endosc Int Open 2023; 11:E893-E898. [PMID: 37810900 PMCID: PMC10558256 DOI: 10.1055/a-2153-7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background and study aims As life expectancy increases worldwide, so does the prevalence of biliary tract and pancreatic disorders, resulting in rising demand for invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) in the elderly. Few studies have assessed the safety of ERCP in patients 90 years and older, particularly among the Hispanic population. The primary aim of this study was to determine the technical success and adverse events (AEs) associated with ERCP in patients 90 years of age or older in comparison to a younger cohort of patients. Patients and methods A retrospective analysis of all ERCPs done at our institution from 2012 to 2018 was performed. Three hundred ERCPs in patients < 90 years old and all 28 ERCPs done in patients ≥ 90 years old were included in the analysis. Results ERCPs were successfully completed in 96.4% of patients > 90 years old and 96.3% of the < 90-year-old cohort (realtive risk [RR] 1.00, confidence interval 0.92-1.07). There was no difference in the rate of periprocedural AEs. Post-ERCP AEs occurred in 7.1% and 3.0% in patients aged < 90 and > 90 years, respectively (RR 2.38, 0.54-10.48). No deaths were directly attributed to the procedure; however, inpatient mortality was higher in the group aged > 90 years. Conclusions ERCP is safe and effective in nonagenarian patients, and advanced age should not be considered an independent risk factor for AEs nor a contraindication for the procedure.
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Affiliation(s)
| | | | - Jorge Vera
- Family Medicine, Bella Vista Hospital, Mayaguez, Puerto Rico
| | - Carlos G Micames
- Division of Gastroenterology, Bella Vista Hospital, Mayaguez, Puerto Rico
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Jalal M, Khan A, Ijaz S, Gariballa M, El-Sherif Y, Al-Joudeh A. Endoscopic removal of common bile duct stones in nonagenarians: a tertiary centre experience. Clin Endosc 2023; 56:92-99. [PMID: 36600656 PMCID: PMC9902683 DOI: 10.5946/ce.2022.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/04/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians. METHODS We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups. RESULTS A total of 125 nonagenarians were compared with 1,370 controls (65-89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days. CONCLUSION Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.
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Affiliation(s)
- Mustafa Jalal
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK,Correspondence: Mustafa Jalal Department of Gastroenterology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK E-mail:
| | - Amaan Khan
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Sijjad Ijaz
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Mohammed Gariballa
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Yasser El-Sherif
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - Amer Al-Joudeh
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
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Dahiya DS, Perisetti A, Sharma N, Inamdar S, Goyal H, Singh A, Rotundo L, Garg R, Cheng CI, Pisipati S, Al-Haddad M, Sanaka M. Racial disparities in endoscopic retrograde cholangiopancreatography (ERCP) utilization in the United States: are we getting better? Surg Endosc 2023; 37:421-433. [PMID: 35986223 DOI: 10.1007/s00464-022-09535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND We identified trends of inpatient therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the United States (US), focusing on outcomes related to specific patient demographics. METHODS The National Inpatient Sample was utilized to identify all adult inpatient ERCP in the US between 2007-2018. Trends of utilization and adverse outcomes were highlighted. P-values ≤ 0.05 were considered statistically significant. RESULTS We noted a rising trend for total inpatient ERCP in the US from 126,921 in 2007 to 165,555 in 2018 (p = 0.0004), with a significant increase in utilization for Blacks, Hispanics, and Asians. Despite an increasing comorbidity burden [Charlson Comorbidity Index (CCI) score ≥ 2], the overall inpatient mortality declined from 1.56% [2007] to 1.46% [2018] without a statistically significant trend (p = 0.14). Moreover, there was a rising trend of inpatient mortality for Black and Hispanic populations, while a decline was noted for Asians. After a comparative analysis, we noted higher rates of inpatient mortality for Blacks (2.4% vs 1.82%, p = 0.0112) and Hispanics (1.17% vs 0.83%, p = 0.0052) at urban teaching hospitals between July toand September compared to the October to June study period; however, we did not find a statistically significant difference for the Asian cohort (1.9% vs 2.10%, p = 0.56). The mean length of stay (LOS) decreased from 7 days in 2007 to 6 days in 2018 (p < 0.0001), while the mean total hospital charge (THC) increased from $48,883 in 2007 to $85,909 in 2018 (p < 0.0001) for inpatient ERCPs. Compared to the 2015-2018 study period, we noted higher rates of post-ERCP pancreatitis (27.76% vs 17.25%, p < 0.0001) from 2007-2014. CONCLUSION Therapeutic ERCP utilization and inpatient mortality were on the rise for a subset of the American minority population, including Black and Hispanics.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.
| | | | - Neil Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA.,Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA, USA.,Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Laura Rotundo
- Section of Digestive Diseases, Yale New Haven Hospital, New Haven, CT, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA
| | - Sailaja Pisipati
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Mohammad Al-Haddad
- Division Chief and Professor of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Madhusudhan Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
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Chen CC, Lin WT, Tung CF, Lee SW, Chang CS, Peng YC. Safety of Nonagenarians Receiving Therapeutic ERCP, Single Center Experience. J Clin Med 2022; 11:jcm11175197. [PMID: 36079126 PMCID: PMC9456670 DOI: 10.3390/jcm11175197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The complication rates for nonagenarians receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP) remain poorly understood. We aimed to determine whether nonagenarians were at an increased risk of ERCP-related complications. (2) Methods: We performed a retrospective study on therapeutic ERCP in nonagenarians from 2011 to 2016 at Taichung Veterans General Hospital. A control group comprising patients aged 65 to 89 years was used to compare demographic data and the outcomes of therapeutic ERCP with the nonagenarians. The risk factors for complications were determined by logistic regression model. (3) Results: There were 35 nonagenarians and 111 patients in the control group. Overall, complication rates were not statistically different between the two groups. However, advanced age was an independent predictor of complications in the multivariate analysis (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.01-1.12; p = 0.049). End stage renal disease (ESRD) was another independent predictor of complications (OR = 4.87; 95% CI = 1.11-21.36; p = 0.036). Post-ERCP pancreatitis and bleeding were more common in ESRD patients than patients without ESRD. (4) Conclusions: Although nonagenarians receiving ERCP did not have more complications compared to elderly patients younger than 90 years, advanced age and comorbidity still affect the outcome of therapeutic ERCP in the elderly patients.
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Affiliation(s)
- Chia-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Wan-Tzu Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chun-Fang Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Shou-Wu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yen-Chun Peng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11230, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
- Correspondence:
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Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Nonagenarians: A Systematic Review and Meta-Analysis. Dig Dis Sci 2022; 67:1352-1361. [PMID: 33770331 DOI: 10.1007/s10620-021-06950-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent advances in modern medicine have translated into increase in life expectancy in the USA and with that, a rise in the demand for invasive procedures in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice for managing various benign and malignant pancreatobiliary conditions and can be associated with various adverse events. AIM We performed a systematic review and meta-analysis to evaluate outcomes of ERCP in nonagenarians. METHODS A comprehensive literature search was performed in Embase, MEDLINE, Web of Science, and Cochrane Review library until July 2020. Our primary outcomes were the rate of technical success and adverse events in nonagenarians. Secondary outcomes were comparison of technical success and adverse events compared with younger patients. RESULTS The initial search revealed 4933 studies, of which 24 studies with 5521 patients met our inclusion criteria. Pooled technical success rate of ERCP in nonagenarians was 92%, and pooled adverse event rate was 7.8%. There was no significant difference in technical success rate and overall rate of adverse events comparing ERCP outcomes in nonagenarians with a relatively younger population. The risk of post-ERCP bleeding was significantly higher in nonagenarians compared to younger patients with OR = 1.986 [1.113-3.544], I2 = 0. ERCP-related mortality was also significantly higher in nonagenarians compared to younger patients with OR = 4.720 [1.368-16.289], I2 = 0. CONCLUSION There was no significant difference in technical success rate and risk of adverse events related to ERCP in nonagenarians compared to younger patients. However, the risk of bleeding and procedure-related mortality was significantly higher.
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Oh DJ, Nam JH, Jang DK, Lee JK. Complications of common bile duct stones: A risk factors analysis. Hepatobiliary Pancreat Dis Int 2021; 20:361-365. [PMID: 33994099 DOI: 10.1016/j.hbpd.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The latest guidelines recommended that common bile duct stones (CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs. METHODS The medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed. RESULTS A total of 634 patients were included and 95 (15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four (6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81 (11.1%) patients within 30 days. CONCLUSIONS It is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm.
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Affiliation(s)
- Dong Jun Oh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang 10326, Korea.
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Sugimoto S, Hattori A, Maegawa Y, Nakamura H, Okuda N, Takeuchi T, Oyamada J, Kamei A, Kawabata H, Aoki M, Naota H. Long-term Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Patients ≥90 Years Old: A Multicenter Retrospective Study. Intern Med 2021; 60:1989-1997. [PMID: 33551408 PMCID: PMC8313914 DOI: 10.2169/internalmedicine.6478-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The safety and prognosis of complete stone removal for the treatment of choledocholithiasis in older patients are unknown. This multicenter retrospective study assessed the outcomes of complete stone removal in elderly patients (≥90 years) with respect to the prognosis. Methods We divided patients who underwent endoscopic cholangiopancreatography for choledocholithiasis into two groups: complete stone removal or incomplete stone removal with plastic stent insertion. The patient characteristics, adverse events, number of endoscopic cholangiopancreatographies, overall survival rates, and disease-specific cumulative death were compared between the groups. Patients Two hundred and twenty-three participants ≥90 years old were included in the study, including 48 (22%) men and 175 (78%) women. The median age was 92 (range, 90-104) years old. There were 160 (72%) and 63 (28%) patients in the complete and incomplete groups, respectively. Results The age, performance status, comorbidities, severe complication rates, and stone diameter were comparable between the groups. The proportion of patients with at least 5 stones was significantly higher in the incomplete group than in the complete group [complete group: 8.1% (13/160) and incomplete group: 21% (13/63), p<0.01]. The overall survival rate was significantly higher in the complete group (p<0.01), while the disease-specific cumulative death rate was higher in the incomplete group (p<0.01). Conclusion Complete stone removal for choledocholithiasis may contribute to a better prognosis in elderly patients ≥90 years old.
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Affiliation(s)
| | - Aiji Hattori
- Division of Gastroenterology, Saiseikai Matsusaka General Hospital, Japan
| | - Yuri Maegawa
- Division of Gastroenterology, Matsusaka Chuo General Hospital, Japan
| | | | - Naoko Okuda
- Division of Gastroenterology, Ise Red Cross Hospital, Japan
| | | | - Jun Oyamada
- Division of Gastroenterology, Ise Red Cross Hospital, Japan
| | - Akira Kamei
- Division of Gastroenterology, Ise Red Cross Hospital, Japan
| | - Hiroyuki Kawabata
- Division of Gastroenterology, Saiseikai Matsusaka General Hospital, Japan
| | - Masatoshi Aoki
- Division of Gastroenterology, Saiseikai Matsusaka General Hospital, Japan
| | - Hiroaki Naota
- Division of Gastroenterology, Matsusaka Chuo General Hospital, Japan
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10
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Inagaki Y, Yoshida N, Hasegawa D, Kassai K, Yasuda R, Inoue K, Hirose R, Dohi O, Okuda T, Inada Y, Okuda K, Ogiso K, Tomie A, Soga K, Murakami T, Itoh Y. The efficacy and safety of colonoscopy in nonagenarians: A multicenter study. Indian J Gastroenterol 2020; 39:557-564. [PMID: 33057909 DOI: 10.1007/s12664-020-01066-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The number of colonoscopy (CS) for the elderly is increasing. There are only a few reports focusing on CS among the very elderly aged ≥ 90-y. We aimed to analyze the efficacy of CS and of colorectal cancer (CRC) for patients aged ≥ 90-y. METHODS We retrospectively analyzed consecutive patients aged ≥ 90-y receiving CS at eight institutions from October 2016 to September 2017. Bowel preparation, complications, and endoscopic diagnosis were analyzed. The non-elderly group aged between 50-y and 64-y and elderly group aged between 65-y and 79-y were compared to very-elderly group aged ≥ 90-y. Through propensity score matching of sex and CS indications (symptomatic or asymptomatic), the number of CRC and the treatment in each group were analyzed. RESULTS We analyzed 125 patients receiving 154 colonoscopies (0.9%) in the very-elderly group from among 16,968 cases. Among 92 cases who received bowel-cleansing solution, good preparations were achieved in 94.5%. The rate of CS-related complications was 1.3% (2/154). The rate of CRC in the very-elderly group was 27.2% (34/125), higher than the non-elderly group (7.2%, 9/125, p < 0.01) and elderly group (8.8%, 11/125, p < 0.01). Therapeutic interventions for CRC in the very-elderly group were performed in 73.5% (24/34) patients. The mean survival of 12 patients with CRC resection was 788 days. CONCLUSIONS CS could be performed safely for the very elderly aged ≥ 90-y with careful considerations. CRC was confirmed to be more frequent in this group with over 70% of patients receiving appropriate therapeutic intervention.
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Affiliation(s)
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | - Kyoichi Kassai
- Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan
| | - Ritsu Yasuda
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Okuda
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujyo Hospital, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Akira Tomie
- Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Koichi Soga
- Department of Gastroenterology, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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11
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Okuda N, Sugimoto S, Nakamura H, Hisada H, Temma T, Hashimoto Y, Hayashi S, Ito T, Takami M, Oyamada J, Kamei A. Is complete stone removal for choledocholithiasis always necessary in extremely elderly patients? JGH Open 2020; 4:16-21. [PMID: 32055692 PMCID: PMC7008169 DOI: 10.1002/jgh3.12198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Endoscopic stone removal has some complications. Although the life expectancy of elderly patients has increased dramatically worldwide, little information is available on the necessity of complete endoscopic stone removal in extremely elderly patients. This study aimed to evaluate the safety and efficacy of complete endoscopic stone removal in extremely elderly patients. METHODS All extremely elderly patients (>90 years) who underwent endoscopic stone removal for choledocholithiasis at our hospital between January 2012 and January 2017 were retrospectively evaluated. The included patients were divided into complete stone removal and incomplete stone removal groups. Complication rate, overall survival (OS), and disease-specific survival (DSS) rates were compared between the two groups. RESULTS Overall, 73 patients were included in this study. The median number of stones was one (range, 0-10) and two (range, 1-12) (P = 0.043), while the median diameter of the largest stones was 9 (range, 0-27) and 14 (range, 5-46) mm (P = 0.001) in the complete and incomplete stone removal groups, respectively. During the follow-up period, OS was 60% and 39% and DSS was 95% and 97% in the complete and incomplete stone removal groups, respectively. Kaplan-Meier analysis found no significant difference in OS and DSS between the two groups (P = 0.052 and P = 0.646, respectively). CONCLUSION Complete stone removal might not always be necessary in extremely elderly patients aged ≥90 years.
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Affiliation(s)
- Naoko Okuda
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
| | | | | | | | - Taishi Temma
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
| | - Yuki Hashimoto
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
| | | | - Tatsuya Ito
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
| | - Mayuko Takami
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
| | - Jun Oyamada
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
| | - Akira Kamei
- Divisions of GastroenterologyIse Red Cross HospitalMieJapan
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12
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Takahashi K, Nihei T, Aoki Y, Nakagawa M, Konno N, Munakata A, Okawara K, Kashimura H. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in patients with native papillae with a performance status score of 3 or 4: A single-center retrospective study. J Rural Med 2019; 14:226-230. [PMID: 31788147 PMCID: PMC6877921 DOI: 10.2185/jrm.19-3007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/02/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: This study aimed to assess the efficacy and safety of therapeutic
endoscopic retrograde cholangiopancreatography (ERCP) in patients with an Eastern
Cooperative Oncology Group performance status (ECOG-PS) score of 3 or 4. Patients and Methods: We reviewed the data of 287 patients with native
papillae who underwent therapeutic ERCP for biliary disease at our hospital between
October 2016 and October 2018. The patients were divided into two groups; those with an
ECOG-PS score of 3 or 4 (group A; n=78) and those with an ECOG-PS score of 0–2 (group B;
n=209). Results: The rate of technical success was not significantly different
between the two groups (95% versus 89%, P=0.13). Although the occurrence
rate of overall adverse events (10% versus 11%, P=0.95) was not
significantly different between the groups, the occurrence rates of aspiration pneumonia
(3.8% versus 0%, P=0.0044) and heart failure (2.6% versus 0%,
P=0.020) were significantly higher in group A. Conclusion: The rates of technical success and overall adverse events did
not significantly differ between patients with an ECOG-PS score of 3 or 4 and those with a
score of 0–2; however, aspiration pneumonia and heart failure were more likely to occur
among patients with an ECOG-PS score of 3 or 4.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Takeshi Nihei
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Yohei Aoki
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Naoaki Konno
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Akari Munakata
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Ken Okawara
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
| | - Hiroshi Kashimura
- Department of Gastroenterology, Mito Saiseikai General Hospital, Japan
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13
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Zhang X, Li G, Pan L, Chen Y, Shi R, Xu W, Zhou K, Cheng Y, Feng Y, Zhou A, Zhao K. The efficacy and safety of one-stage endoscopic treatment for ascending acute cholangitis caused by choledocholithiasis with severe comorbidities. Surg Endosc 2019; 34:3963-3970. [PMID: 31586253 DOI: 10.1007/s00464-019-07168-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/24/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Emergency endoscopic retrograde cholangiopancreatography (ERCP) for ascending acute cholangitis in patients with severe comorbidities is challenging. Here, we evaluated the efficacy and safety of one-stage ERCP in such patients by performing a retrospective study. METHODS We included all patients with ascending acute cholangitis and undergoing ERCP between January 2017 and March 2019. In total, we recruited 212 patients: 74 and 138 with and without severe comorbidities, respectively. We collected and analyzed data related to basal characteristics, ERCP, and clinical outcomes. RESULTS Elderly age (76.20 ± 9.99 years vs. 66.52 ± 8.16 years, P = 0.000), higher levels of leukocyte count (15.86 ± 2.47 × 109/ml vs. 13.49 ± 1.65 × 109/ml, P = 0.000), and serum bilirubin (3.11 ± 1.29 mg/dl vs. 1.94 ± 0.90 mg/dl, P = 0.000) were present in patients with severe comorbidities. A significantly higher proportion of these patients were severe cases (32.4% vs. 6.5%, P = 0.000), American Society of Anesthesiologists (ASA) stage V status (37.8% vs. 10.1%, P = 0.000) and had undergone general anesthesia (56.8% vs. 18.8%, P = 0.000). Successful biliary cannulation and complete stone clearance in one session were achieved in 207 and 202 patients, respectively. Mean length of hospital stay was 8.02 ± 2.71 days. Forty-three patients required ICU stay with the mean length of 3.26 ± 3.51 days. In-hospital mortality occurred in seven patients; all these patients had severe comorbidities. ERCP details, including urgent and early ERCP, biliary cannulation, complete stone clearance in one session, stent insertion, and complications were not significantly different between the two groups. Patients with severe comorbidities had a longer in-hospital stay (9.39 ± 3.15 days vs. 7.29 ± 2.11 days, P = 0.000), a higher proportion of ICU admission (45.9% vs. 6.5%, P = 0.000), and a longer ICU stay length (4.88 ± 4.37 days vs. 1.44 ± 0.52 days, P = 0.000). Our data also revealed that early diagnosis is an important predictor associated with clinical outcomes. CONCLUSIONS One-stage ERCP is safe and effective for ascending acute cholangitis caused by choledocholithiasis. Early diagnosis is a significant predictor of clinical outcomes.
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Affiliation(s)
- Xiaoping Zhang
- Department of Gastroenterology, Jintan People Hospital Afflilated with Jiangsu University, 16 Nanmen Road, Jintan, 213200, China
| | - Guiqin Li
- Department of Gastroenterology, Lianshui People Hospital, 6 Hongri Road, Lianshui, 223400, China
| | - Liang Pan
- Department of Gastroenterology, Jintan People Hospital Afflilated with Jiangsu University, 16 Nanmen Road, Jintan, 213200, China
| | - Yue Chen
- Department of Gastroenterology, Lishui People Hospital, 86 Chongwen Road, Nanjing, 211200, China
| | - Ruihua Shi
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Wei Xu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Kun Zhou
- Department of Gastroenterology, Lianshui People Hospital, 6 Hongri Road, Lianshui, 223400, China
| | - Yajun Cheng
- Department of Gastroenterology, Lianshui People Hospital, 6 Hongri Road, Lianshui, 223400, China
| | - Yadong Feng
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
| | - Aijun Zhou
- Department of Gastroenterology, Lianshui People Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Kai Zhao
- Department of Gastroenterology, Jintan People Hospital Afflilated with Jiangsu University, 16 Nanmen Road, Jintan, 213200, China.
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14
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Endoscopic retrograde cholangiopancreaticography in elderly patients: A reliable alternative in sepsis. North Clin Istanb 2018; 5:169-170. [PMID: 30374488 PMCID: PMC6191553 DOI: 10.14744/nci.2018.92679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
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15
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Lee DW, Kim HG. Age is Important, but Patient Status is also Important in Endoscopic Retrograde Cholangiopancreatography. Clin Endosc 2018; 51:315-316. [PMID: 30078303 PMCID: PMC6078919 DOI: 10.5946/ce.2018.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/15/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Dong Wook Lee
- Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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