Advanced Age: A Predictor Of Difficut Lithiasis During ERCP?

Aims Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone extraction using a Dormia balloon or a basket is the standard treatment for common bile duct (CBD) stones. When the clearance of the CBD cannot be obtained by standard techniques, it is referred to as difficult lithiasis. Advanced age is one of the causes of difficult lithiasis (1,2). The objective of this study was to identify parameters that could explain the higher failure rate in older age.

Methods This is a retrospective study that included all patients who had ERCP for common bile duct stones between January 2014 and December 2017. The patients were divided into two groups:

group 1: patients aged> 65 years and

group 2: patients aged ≤ 65 years. Epidemiological, clinical, para-clinical and endoscopic data were compared between the two groups. The statistical study was carried out with SPSS software (p significant if <0.05).

Results We included 182 patients who were divided into: group 1 (n = 86) andgroup 2 (n = 95). The main characteristics of the two groups are summarized in the table below:

Tab. 1

Characteristics	G 1 > 65 years (n = 86)	G 2 ≤ 65 years (n = 95)	p
Epidemiology
Sex [M/W]	26/60	22/58	0,698
Cholecystectomy	70 %	65 %	0,512
Indications
Residual lithiasis	70 %	65 %	0,512
Sequential treatement	10 %	21 %	0,055
Clearance of CBD stones without gallbladder removal	20 %	14 %	0,301
Biology
ASAT (ULN)	2 (1-8)	2,8 (1-14)	0,244
ALAT (ULN)	2,2 (1-15)	3,5 (1-12)	0,090
Bilirubin (µmol/l)	39,9 (2-133)	59,5 (3-282)	0,170
Hb (g/dl)	12,5 (8-16)	12,9 (9,5-16,8)	0,305
PT (%)	91,5	89,4 %	0,402
Endoscopy
Small papilla	31 %	29,5 %	0.839
Eccentric papilla	3,5 %	2,6 %	0,731
Intra-diverticular papilla	7,1 %	2,6 %	0,185
Para-diverticular papilla	22,4 %	6,4 %	0.004
Papilla hidden by a fold	1,2 %	1,3 %	0.951
Diameter of the CBD (mm)	15,6 (7-30)	12,45 (7-30)	<10-3
Stone size (mm)	12,36 (5-25)	13,7 (9,5-16,8)	0,539
Average stones number	1,8	1,2	0,026
>3 stones	17,4 %	8,8 %	0.134
Stenosis of the CBD	4 %	2,9 %	0.731
Impacted stone	6,7 %	0	0.030
Clearance of the CBD	54,7 %	70 %	0.042

ALAT: Alanine amino-transférase

ASAT: Aspartate amino-transférase

CBD: common bile duct

Hb: Hémoglobin

ULN: upper limit of normal

PT: prothrombin time

Conclusions In our series, the failure rate of ERCP was higher in the elderly. This could be explained by the higher frequencies of para-diverticular papilla and impacted stones, a larger diameter of the CBD and a higher average number of stones.

Citation: Nakhli A, Sabbah M, Trad D et al. OP192 ADVANCED AGE: A PREDICTOR OF DIFFICUT LITHIASIS DURING ERCP?. Endoscopy 2021; 53: S79.

Publication History

Article published online:
19 March 2021