2005, Number 5
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Rev Invest Clin 2005; 57 (5)
Endoscopic retrograde cholangiopancreatography in the elderly
Ávila-Funes JA, Montaño-Loza A, Zepeda-Gómez S, Meza-Junco J, Melano-Carranza E, Valdovinos-Andraca F, Valdovinos-Díaz MA, de León-Rosales SP
Language: Spanish
References: 35
Page: 666-670
PDF size: 53.55 Kb.
ABSTRACT
Background. Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of biliary and pancreatic diseases.
Objective. To know the complication rate of ERCP in the elderly.
Patients and methods. Patient files who underwent ERCP were reviewed and were divided into two groups: aged 65 and older (group 1) and less than 65 years (group 2). Socio-demographic variables, prophylactic antibiotic use, indications for ERCP and outcomes were assessed.
Results. Mean age in group 1 was 72.9 years and 41.7 years in group 2. Group 1 had more comorbidity (p ‹ 0.001). The most frequent indication for the procedure was obstructive jaundice in both groups (63% versus 44%; p = 0.002). Malignancy was more frequent as a cause of biliary obstruction in group 1 (45% versus 21%; p ‹ 0.001). ERCP was performed once in 76% in group 1 and 93% in group 2 (p = 0.001). Prophylactic antibiotics were used more frequently in group 1 (84% versus 60%; p ‹ 0.001). There were no differences between groups regarding infectious complications (p = 0.700). There was no difference in mortality rates between groups.
Conclusion. ERCP is a safe procedure in elderly patients. The elderly frequently have more comorbidity. Nevertheless, the complication and mortality rates did not differ in this study. It is noteworthy that elderly patients received prophylactic antibiotics more frequently than younger patients but infectious complications were not different. The patients should not be excluded from ERCP based on their age.
REFERENCES
Oi I, Kobayashi S, Kondo T. Endoscopic pancreatocholangiography. Endoscopy 1970; 2: 103-6.
Kawai K, Akasaka Y, Murakami K, et al. Endoscopic sphincterotomy of the ampulla’s Vater. Gastrointest Endosc 1974; 20: 148-51.
Siddique I, Galati J, Ankoma-Sey V, et al. The role of choledoscopy in the diagnosis and management of biliary tract diseases. Gastrointest Endosc 1999; 50: 67-73.
Cotton PB. Evaluating ERCP is important but difficult. Gut 2002; 51: 287-9.
Lockhart SP, Schofield PM, Gribble RJN, et al. Upper gastrointestinal endoscopy in the elderly. BMJ 1985; 290: 283.
Brussaard CC, Vandewoude MFJ. A prospective analysis of elective upper gastrointestinal endoscopy in the elderly. Gastrointest Endosc 1988; 34: 118-21.
De la Mora G, Marcon NE. Endoscopy in the elderly. Best Pract Res Clin Gastroenterol 2001; 15: 999-1012.
MacMahon M, Walsh TN, Brennan P, et al. Endoscopic retrograde cholangiopancreatography in the elderly: a single unit audit. Gerontology 1993; 39: 28-32.
Seinelä L, Ahvenainen J, Rönneikkö J, et al. Reasons for and outcome of upper gastrointestinal endoscopy in patients aged 85 years or more: retrospective study. BMJ 1998; 317: 575-80.
Scapa E, Berant A, Leibovitz A, et al. Endoscopic retrograde cholangiopancreatography in octagenarians. J Clin Gastroenterol 1996; 22: 21-2.
Cooper BT, Neumann CS. Upper gastrointestinal endoscopy in patients aged 80 years or more. Age Ageing 1986; 15: 343-9.
Safe AF, Owens D. Upper gastrointestinal endoscopy in octogenarians. Br J Clin Pract 1991; 45: 99-101.
Sugiyama M, Atomi Y. Endoscopic sphinterotomy for bile duct stones in patients 90 years of aged and older. Gastrointest Endosc 2000; 52: 187-91.
Elizondo J, Gallo S, Valdovinos MA, et al. Retrospective evaluation of 500 endoscopic cholangiopancreatographies performed at the Instituto Nacional de la Nutrición Salvador Zubirán. Rev Gastroenterol Mex 1989; 54: 19-26.
Loperfido S, Angelini G, Benedetti G. Major early complications from diagnostic and therapeutic ERCP: A prospective multicenter study. Gastrointest Endosc 1998; 48: 1-10.
Cotton PB. Outcomes of endoscopy procedures: Struggling towards definitions. Gastrointest Endosc 1994; 40: 514-18.
Freeman ML, Nelson DB, Sherman S. Complications of endoscopic biliarysphincterotomy. N Engl J Med 1996; 335: 909-18.
Tanner AR. ERCP: Present practice in a single region. Suggested standards for monitoring performance. Eur J Gastroenterol Hepatol 1996; 8: 145-8.
Margulies C, Siquiera ES, Silverman WB. The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses. Gastrointest Endosc 1999; 49: 716-19.
Maxton DG, Tweedle DR, Martin DF. Retained common bile duct stones after endoscopic sphinterotomy: temporary and long-term treatment with biliary stenting. Gut 1995; 36: 446-9.
Ashton CE, McNabb WR, Wilkinson ML, et al. Endoscopic retrograde cholangiopancreatography in elderly patients. Age Aging 1998; 27: 683-8.
Subhani JM, Kibbler C, Dooley JS. Review article: Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). Aliment Pharmacol Ther 1999; 13: 103-16.
Cotton PB, Lehman G, Vennes J. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastroenterol Endosc 1991; 37: 383-93.
Ingoldby CJH, El-Saadi J, Hall RI. Late results of endoscopic sphincterotomy for bile duct stones in elderly patients and gallbladder in situ. Gut 1989; 30: 1129-31.
Crocker JR, Williams SG, Charlton M. Endoscopic therapy for bile duct stones in geriatric population. Post Med J 1992; 68: 457-60.
Masci E, Toti G, Mariani A. Complications of diagnostic and therapeutic ERCP: A prospective multicenter study. Am J Gastroenterol 2001; 96: 417-23.
Ho KY, Montes H, Sossenheimer MJ. Features that may predict hospital admission following outpatient therapeutic ERCP. Gastrointest Endosc 1999; 49: 587-92.
Fleischer DE. Better definition of endoscopic complications and other negative outcomes. Gastrointest Endosc 1994; 40: 511-14.
Mitchell RMS, O’Connor F, Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol 2003; 36: 72-4.
Deans GT, Sedman P, Martín D, et al. Are complications of endoscopic sphincterotomy age related? Gut 1997; 41: 545-8.
Shemesh E, Czerniak A, Shneabaum S. Early endoscopic sphincterectomy in the management of acute gallstone pancreatitis in elderly patients. JAGS 1990; 38: 893-6.
Mehta SN, Pavone E, Barkun JS, et al. Predictors of post-ERCP complications in patients with suspected choledocholithiasis. Endoscopy 1998; 30: 457-63.
Montaño-Loza A, Valdovinos F, Valdovinos MA. Profilaxis antimicrobiana en colangiopancreatografia retrógrada endoscópica. Rev Gastroenterol Mex 2002; 67 (Suppl. l): 132-3.
Dajani AS, Taubert KA, Wilson W. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1997; 277: 1794-1801.
Meijer WS, Schmitz PI, Jeekel J. Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Br J Surg 1990; 77: 283-90.