Clinical application value of therapeutic endoscopic retrograde cholangiopancreatography in super-aged patients
10.3760/cma.j.issn.1673-4904.2019.09.004
- VernacularTitle: 治疗性内镜逆行胰胆管造影术在超高龄患者中的临床应用价值分析
- Author:
Lujie MIAO
1
;
Dong SHAO
;
Yun ZHUANG
;
Fu XU
;
Jianping CHEN
Author Information
1. Department of Gastroenterology, Changzhou First People′s Hospital of Jiangsu Province, the Third Affiliated Hospital of Soochow University, Jiangsu Changzhou 213000, China
- Publication Type:Journal Article
- Keywords:
Cholangiopancreatography, endoscopic retrograde;
Aged;
Retrospective studies
- From:
Chinese Journal of Postgraduates of Medicine
2019;42(9):782-786
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the value and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients.
Methods:The clinical data of 377 elderly patients with therapeutic ERCP from January 2010 to September 2017 in Changzhou First People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, there were 34 patients (observation group) aged ≥ 90 years and 343 patients (control group) aged 75 to 89 years old. The results of ERCP examination, treatment of bile duct stones and related complications were compared between 2 groups.
Results:There was no statistical difference in the success rate of ERCP between 2 groups (P>0.05). There were no statistical difference in detection rates of bile duct stones, cholangiocarcinoma and benign biliary stricture between 2 groups (P<0.05); however, the detection rates of duodenal papillary carcinoma and nipple diverticulum in observation group were significantly higher than those in control group: 11.8% (4/34) vs. 2.0% (7/343) and 38.2% (13/34) vs. 18.7% (64/343), and there were statistical differences (χ2 = 10.326 and 7.294, P<0.01). There were 21 patients with bile duct stones in observation group, including 14 patients with multiple stones; there were 241 patients with bile duct stones in control group, including 188 patients with multiple stones. The maximum stone diameter, rate of in-line stent drainage and rate of extracorporeal lithotripsy in multiple stones patients of observation group were significantly higher than those in multiple stones patients of control group: (1.5 ± 0.3) cm vs. (1.2 ± 0.4) cm、9.5% (2/21) vs. 1.7% (4/241), 4.8% (1/21) vs. 0.4% (1/241), and there were statistical differences (P<0.05). There was no statistical difference in incidence of ERCP complications between observation group and control group: 14.7% (5/34) vs. 6.7% (23/343), P>0.05; but the incidence of cardiac accidents in observation group was significantly higher than that in control group: 5.9% (2/34) vs. 1.2% (4/343), and there was statistical difference (χ2 = 4.393, P<0.05). There was no statistical difference in the length of hospital stay between observation group and control group: (11.5 ± 5.0) d vs. (13.2 ± 5.8), P>0.05.
Conclusions:Therapeutic ERCP is an important treatment for elderly patients with biliary and pancreatic diseases. For patients over 90 years old, ERCP is safe and reliable, but it is necessary to actively pay attention to comorbidities, especially cardiac function.
