Year 2024 / Volume 116 / Number 5
Original
Endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis in older patients

244-249

DOI: 10.17235/reed.2023.10051/2023

Júlia Gardenyes, Pere Roura, Helena Vallverdú-Cartie, Judit Hermoso-Bosch, Clàudia Roca, Mariona Espaulella, Antoni Casals, Héctor Ivo Marani, Joan Saló, Martín Galdín, Marta Gallach, Carles Leal,

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.
Lay Summary
The rise in life expectancy could be leading to an increased rate of admissions due to symptomatic bile duct stones in older patients, and the primary approach should be endoscopic retrograde cholangiopancreatography (ERCP). Our hospital uses the endoscopic procedure frequently in patients aged 85 and older. Although technical adverse event rates are similar to those of younger adults, medical events appear frequently. The survival rate is significantly lower in patients who develop any adverse event. We plan to strengthen our care plans for older adults and hope to reduce the medical complications experienced post ERCP.
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References
1. Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: Management and outcomes. Gut. 1997;41(4):433–5.
2. Labarias C, Leguillou Cé, Bourgaux JF. La cholangio-pancréatographie rétrograde endoscopique chez le sujet âgé de plus de 75 ans: Cohorte descriptive. Geriatr Psychol Neuropsychiatr Vieil. 2017;15(4):377–82. DOI : 10.1684/pnv.2017.0696
3. Takahashi K, Tsuyuguchi T, Sugiyama H, et al. Risk factors of adverse events in endoscopic retrograde cholangiopancreatography for patients aged ≥ 85 years. Geriatr Gerontol Int. 2018;18(7):1038–45.
4. Galeazzi M, Mazzola P, Valcarcel B, et al. Endoscopic retrograde cholangiopancreatography in the elderly: Results of a retrospective study and a geriatricians’ point of view. BMC Gastroenterol. 2018;18(1):1–8.
5. Hui CK, Liu CL, Lai KC, C, et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Aliment Pharmacol Ther. 2004;19(11):1153–8.
6. Garcia C, Lopez O, Islam S, et al. Endoscopic Retrograde Cholangiopancreatography in the Elderly. Am J Med Sci. 2016;351(1):84–90.
7. Tohda G, Ohtani M, Dochin M. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly. World J Gastroenterol. 2016;22(37):8382–8.
8. Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8–35.
9. Collin C, Wade DT, Davies S, Horne V. The barthel ADL index: A reliability study. Disabil Rehabil. 1988;10(2):61–3.
10. Cotton P, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383–93.
11. Mallery J, Baron T, Dominitz J, et al. Complications of ERCP. Gastrointest Endosc. 2003;57(6):633–8.
12. Cotton P, Eisen G, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446–54.
13. Boyd CM, Landefeld CS, Counsell SR, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008;56(12):2171–9.
14. Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992;326(24):1582–6.
15. Harness J, Strodel W, Talsma S. Symptomatic biliary tract disease in the elderly patient. Am Surg. 1986;52(8):442–5. PMID: 3729184
16. Sobani ZA, Yunina D, Abbasi A, et al. Endoscopic retrograde cholangiopancreatography in nonagenarian patients: Is it really safe? Clin Endosc. 2018;51(4):375–80.
17. Yun DY, Han J, Oh JS, Park KW, Shin IH, Kim HG. Is endoscopic retrograde cholangiopancreatography safe in patients 90 years of age and older? Gut Liver. 2014;8(5):552–6.
18. Katsinelos P, Paroutoglou G, Kountouras J, Zavos C, Beltsis A, Tzovaras G. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older. Gastrointest Endosc. 2006;63(3):417–23.
19. Han SJ, Lee TH, Kang B Il, et al. Efficacy and Safety of Therapeutic Endoscopic Retrograde Cholangiopancreatography in the Elderly Over 80 Years. Dig Dis Sci. 2016;61(7):2094–101.
20. Fisher L, Fisher A, Thomson A. Cardiopulmonary complications of ERCP in older patients{A figure is presented}. Gastrointest Endosc. 2006;63(7):948–55.
21. ASGE Standards Of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc [Internet]. 2017;85(1):32–47. Available from: http://dx.doi.org/10.1016/j.gie.2016.06.051
22. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102(8):1781–8.
23. Tarar ZI, Farooq U, Gandhi M, Saleem S, Daglilar E. Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis. Clin Endosc. 2023;1–12.
24. Fulmer T, Mezey M, Bottrell M, et al. Nurses Improving Care for Health System Elders (NICHE): using outcomes and benchmarks for evidence-based practice. Geriatr Nurs (Minneap). 2002;23(3):121–7.
25. Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM. The hospital elder life program: A model of care to prevent cognitive and functional decline in older hospitalized patients. J Am Geriatr Soc. 2000;48(12):1697–706.
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Gardenyes J, Roura P, Vallverdú-Cartie H, Hermoso-Bosch J, Roca C, Espaulella M, et all. Endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis in older patients. 10051/2023


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Publication history

Received: 30/10/2023

Accepted: 22/11/2023

Online First: 30/11/2023

Published: 09/05/2024

Article revision time: 18 days

Article Online First time: 31 days

Article editing time: 192 days


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