Difficult Biliary Stones in the Elderly: Endoscopic Retrograde Cholangiography. A Single Surgical Tertiary Center Experience With Follow Up

Aims Pancreaticobiliary diseases and choledocholithiasis are common in elderly patients. Endoscopic treatment of biliary stones represents a well-established mini-invasive technique. However, limited data are available regarding the treatment of “difficult” biliary stones in elderly population. The aim of our study is to evaluate the efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients ≥85 years of age with complex biliary stones.

Methods From January 2015 to January 2017, data from ERCP procedures performed for complex biliary stones were retrospectively collected. The patients were divided into two groups based on their age: group A 85 years old or older and group B 65 years or younger. Demographic data, success, complications and recurrence rates for both groups were reported.

Results 280 patients over 85 years and 435 patients younger than 65 years old underwent ERCP for biliary stones during study period. The mean age of group A was 88.2±2.5 years and 50.4±10.8 years for group B. “Difficult” biliary stones were diagnosed in 110 patients among elderly (39.2 %; group A) and in 62 cases among patients younger than 65 years old (14.2 %; group B). Chronic comorbidities (86.3 % vs 24.2 %; p<0.001) and use of antithrombotic drugs (48.2 % vs 19.3 %; p<0.001) were more frequent in the elderly. Technical success rate (95.4 % vs 96.7 %; p>0.6) and complications rate (8.2 % vs 13 %; p>0.2) were not different among the two groups (Table1). Periampullary diverticula (PAD) were observed more frequently in group A (38.1 % vs 17.7 %; p<0.006). More patients from group B underwent cholecystectomy during the same admission (8.2 % vs 42.3 %; p<0.001). Recurrence rate was not different among the groups (7.6 % vs 5 %; p>0.5). PAD was identified as risk factor for recurrence (p<0.02).

Conclusions ERCP in the elderly was found to be a safe procedure, carrying a high degree of success for the treatment of difficult biliary stones.

Citation: Antypas P, Cereatti F, Fiocca F et al. OP190 DIFFICULT BILIARY STONES IN THE ELDERLY: ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY. A SINGLE SURGICAL TERTIARY CENTER EXPERIENCE WITH FOLLOW UP. Endoscopy 2021; 53: S79.

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Artikel online veröffentlicht:
19. März 2021