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Wang S, Lu Q, Zhou Y, Zhang H. Efficacy and safety of endoscopic retrograde cholangiopancreatography in patients over 75 years of age. J Minim Access Surg 2023; 19:193-201. [PMID: 37056083 PMCID: PMC10246631 DOI: 10.4103/jmas.jmas_325_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 04/15/2023] Open
Abstract
Background To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly choledocholithiasis patients compared with younger groups. Methods This was a case-control study conducted from January 2018 to December 2020 at Fuyang People's Hospital, with 596 patients included. Patients who underwent ERCP were classified as two groups based on age stratification definitions from the National Institute of Health and the World Health Organisation: Patients <75 ages (n = 204) and patients ≥75 ages (n = 392). Demographic characteristics, details of endoscopic therapy, complications were retrospectively reviewed and compared between two groups. The subgroup was pre-formed to further explore the efficacy and safety of ERCP in the elderly population. Results Between patients ≥75 ages and patients <75 ages, there were no significant differences in the complete stone removal rate and a second ERCP. Intubation difficulty (odds rate [OR]: 1.723, 95% confidence interval [CI]: 1.118-2.657) and longer ERCP operation time (β = 4.314, 95% CI: 2.366-6.262) were observed in the elderly group at a higher frequency than the younger group. Elder patients were more likely to have intra-operative complications (χ2 = 18.158, P < 0.001), and post-operative complications (χ2 = 8.739, P = 0.003). In the subgroup group, ERCP was efficacious and safe in elderly patients with comorbidities. Conclusions ERCP may be efficaciously performed on elderly patients. However, intra-operative and post-operative complications of ECRP should also be taken into consideration when selecting therapeutic options.
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Affiliation(s)
- Shuangping Wang
- Department of Gastroenterology, Fuyang People’s Hospital, Fuyang, P.R. China
| | - Qifeng Lu
- Department of Gastroenterology, Fuyang People’s Hospital, Fuyang, P.R. China
| | - Yabai Zhou
- Department of Gastroenterology, Fuyang People’s Hospital, Fuyang, P.R. China
| | - Hao Zhang
- Department of Clinical Medicine, Wannan Medical College, Wuhu, P.R. China
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Guo JY, Zhu JH, Pan J, Wang YC, Qian YY, Hu LH, He CH, Zou WB. Increased severity of complications after therapeutic ERCP in geriatric patients with chronic pancreatitis: An observational study. Medicine (Baltimore) 2022; 101:e29753. [PMID: 35801792 PMCID: PMC9259179 DOI: 10.1097/md.0000000000029753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Studies of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in geriatric patients have mainly examined patients with biliary diseases, rather than chronic pancreatitis (CP). This study aimed to evaluate the safety and success rate of therapeutic ERCP in geriatric patients with CP. The medical records of patients with CP aged over 65 years (group A) were retrospectively collected in a tertiary hospital from January 2013 to December 2018. Sex-matched CP patients under 65 years (group B) were randomly selected into the control group (matching ratio = 1:2). The success rate and the complication rate of therapeutic ERCP in 2 groups were compared. The risk factors for post-ERCP pancreatitis were investigated by univariate and multivariate analyses. A total of 268 ERCPs were performed in 179 patients of group A and 612 ERCPs in 358 patients of group B. The success rate of ERCP in group A was similar to that of group B (92.16% vs 92.32%; P = .936). The overall incidence of post-ERCP complications was 7.09% (19/268) and 5.72% (35/612) in group A and B, respectively (P = .436). However, geriatric patients had a significantly increased occurrence of moderate to severe complications (2.61% vs 0.16%; P = .002). Female gender (odds ratio [OR] = 3.40; P = .046), pancreas divisum (OR = 7.15; P = .049), dorsal pancreatogram (OR = 7.40; P = .010), and lithotripsy (OR = 0.15; P = .016) were significantly associated with risk of post-ERCP pancreatitis in geriatric patients. Therapeutic ERCP is safe and feasible in elderly patients with CP. However, occurrence of moderate to severe complications after ERCP increased in geriatric patients.
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Affiliation(s)
- Ji-Yao Guo
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Jia-Hui Zhu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Yuan-Chen Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Yang-Yang Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
| | - Chao-Hui He
- Department of Gastroenterology, the Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
- *Correspondence: Chao-Hui He, Department of Gastroenterology, the Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China (e-mail: )
| | - Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China
- Shanghai Institute of Pancreatic Diseases, Shanghai, China
- *Correspondence: Chao-Hui He, Department of Gastroenterology, the Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China (e-mail: )
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Taşkıran İ, Ödemiş B, Yıldız H, Parlak E. Is Outpatient ERCP Safe for Choledocholithiasis? MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2021.70370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Tokmak S, Cetin MF, Torun S. Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine. Geriatr Gerontol Int 2021; 21:887-892. [PMID: 34427037 DOI: 10.1111/ggi.14252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/14/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
AIM The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. METHODS In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged ≥80 years (Group A) and 173 patients (193 procedures) were aged ≤65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. RESULTS The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). CONCLUSIONS ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int 2021; 21: 887-892.
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Affiliation(s)
- Salih Tokmak
- Department of Gastroenterology, Internal Medicine, Duzce University, Duzce, Turkey
| | | | - Serkan Torun
- Department of Gastroenterology, Internal Medicine, Duzce University, Duzce, Turkey
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Gotoda T, Akamatsu T, Abe S, Shimatani M, Nakai Y, Hatta W, Hosoe N, Miura Y, Miyahara R, Yamaguchi D, Yoshida N, Kawaguchi Y, Fukuda S, Isomoto H, Irisawa A, Iwao Y, Uraoka T, Yokota M, Nakayama T, Fujimoto K, Inoue H. Guidelines for sedation in gastroenterological endoscopy (second edition). Dig Endosc 2021; 33:21-53. [PMID: 33124106 DOI: 10.1111/den.13882] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release up-to-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.
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Affiliation(s)
- Takuji Gotoda
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takuji Akamatsu
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Seiichiro Abe
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Yousuke Nakai
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Waku Hatta
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naoki Hosoe
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Yoshimasa Miura
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Ryoji Miyahara
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naohisa Yoshida
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Shinsaku Fukuda
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hajime Isomoto
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Atsushi Irisawa
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Yasushi Iwao
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Toshio Uraoka
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazuma Fujimoto
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Haruhiro Inoue
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
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Hakuta R, Kogure H, Nakai Y, Hamada T, Sato T, Suzuki Y, Inokuma A, Kanai S, Nakamura T, Noguchi K, Ishigaki K, Saito K, Saito T, Takahara N, Mizuno S, Yamada A, Tada M, Koike K. Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly. Endosc Int Open 2020; 8:E1202-E1211. [PMID: 32904855 PMCID: PMC7458759 DOI: 10.1055/a-1216-1363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74-2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.
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Affiliation(s)
- Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Suzuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiyuki Inokuma
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kanai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoka Nakamura
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensaku Noguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunaga Ishigaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kei Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Tada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Zhou Y, Zha WZ, Fan RG, Jiang GQ, Wu XD. Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:176-181. [PMID: 30507246 DOI: 10.17235/reed.2018.5822/2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. METHODS a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. RESULTS the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. CONCLUSIONS the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.
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Affiliation(s)
- Yong Zhou
- General Surgery, Yancheng City NO.1 People's Hospital, china
| | | | | | - Guo-Qin Jiang
- The Second Affiliated of Hospital of Soochow University
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Ribeiro Gomes AC, Pinho R, Rodrigues A, Ponte A, Carvalho J. Enteroscopy in the Elderly: Review of Procedural Aspects, Indications, Yield, and Safety. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:18-28. [PMID: 31970236 DOI: 10.1159/000499678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/25/2019] [Indexed: 12/14/2022]
Abstract
Background As human longevity continues to increase, age-related diseases are more common, which leads to a higher use of gastroenterology services. Endoscopic procedures are generally considered to be of higher risk in the elderly with multiple comorbidities. However, some endoscopic techniques have already been proved to be well tolerated in the elderly. Summary <underline></underline>Enteroscopy enables the nonsurgical diagnosis and therapeutic management of a wide variety of small bowel diseases. Although it has been shown to be safe and effective, with high diagnostic yield and therapeutic success rate in the general population, its safety and efficacy in the elderly is largely unknown, and there are still some concerns about its use in these patients. Key Messages This review will focus on enteroscopy in elderly people, taking into account patient and procedure characteristics, indications, findings, yield, and complication rate.
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Affiliation(s)
- Ana Catarina Ribeiro Gomes
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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García García de Paredes A, Mateos Muñoz B, Albillos A. [Gastrointestinal endoscopy in patients of advanced age]. Rev Esp Geriatr Gerontol 2018; 53:293-298. [PMID: 29598971 DOI: 10.1016/j.regg.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
Abstract
The dramatic increase in life expectancy is leading to a significant increase in the use of gastrointestinal endoscopy in the elderly. Taking into account these demographic changes, the use of gastrointestinal endoscopy in this age group is of great importance. Although these procedures are generally safe and well tolerated even in very elderly patients, the onset of physiological changes associated with aging and the increased prevalence of cardiovascular and pulmonary comorbidities raise the risk of sedation related complications in these patients. Age alone is not a contraindication for performing any endoscopic procedure. However, elderly patients have their own peculiarities that require a detailed review of the characteristics, risks and benefits of endoscopic procedures in this specific context.
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Affiliation(s)
- Ana García García de Paredes
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - Beatriz Mateos Muñoz
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - Agustín Albillos
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018; 35:6-24. [DOI: 10.1097/eja.0000000000000683] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Han SJ, Lee TH, Park SH, Cho YS, Lee YN, Jung Y, Choi HJ, Chung IK, Cha SW, Moon JH, Cho YD, Kim SJ. Efficacy of midazolam- versus propofol-based sedations by non-anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years. Dig Endosc 2017; 29:369-376. [PMID: 28181706 DOI: 10.1111/den.12841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM As society ages, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. This prospective comparative study evaluated the safety and efficacy of midazolam- versus propofol-based sedations by non-anesthesiologists during therapeutic ERCP in patients over 80 years of age. METHODS A total of 100 patients over 80 years of age who required therapeutic ERCP were enrolled and randomly received midazolam + fentanyl (MF group) or propofol + fentanyl (PF group) sedation. Endoscopic sedation was titrated to a moderate level and carried out by trained registered nurses. Main outcome measurements were sedation safety in terms of cardiopulmonary components and efficacy measured on a 10-point visual analogue scale (VAS). RESULTS Regarding safety, hypoxia occurred in seven (14%) in the MF group and in eight patients (16%) in the PF group (P = 0.779). Increased O2 supply was more frequent in the PF group (32% vs 42%), albeit not significantly so. There were no differences in the frequency of hypotension, bradycardia or tachycardia between the two groups. Mean VAS score for overall satisfaction with sedation by patients, endoscopists, and nurses and the scores for pain during the procedures were not different between the two groups. There was no significant difference in the procedure outcomes or rate of ERCP-related complications. CONCLUSIONS There were no significant differences of safety and efficacy between midazolam- and propofol-based sedation in patients over 80 years of age. Increased O2 supply was more frequent in the propofol group, but the prevalence of hypoxia did not differ significantly.
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Affiliation(s)
- Su Jung Han
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Tae Hoon Lee
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Sang-Heum Park
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Young Sin Cho
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Yun Nah Lee
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea
| | - Yunho Jung
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Hyun Jong Choi
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea
| | - Il-Kwun Chung
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Sang-Woo Cha
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Jong Ho Moon
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, South Korea
| | - Young Deok Cho
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Sun-Joo Kim
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
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Ahmed M, Kanotra R, Savani GT, Kotadiya F, Patel N, Tareen S, Fasullo MJ, Kesavan M, Kahn A, Nalluri N, Khan HM, Pau D, Abergel J, Deeb L, Andrawes S, Das A. Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience. Endosc Int Open 2017; 5:E261-E271. [PMID: 28382324 PMCID: PMC5378548 DOI: 10.1055/s-0043-102402] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013. There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.
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Affiliation(s)
- Moiz Ahmed
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Ritesh Kanotra
- Department of Internal Medicine, Banner Baywood Medical Center, Mesa, Arizona, USA,Corresponding author Ritesh Kanotra 1139 W Spur AvenueGilbert, AZ 85233+1-646-515-8435
| | | | | | - Nileshkumar Patel
- Department of Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Florida, United States
| | - Sarah Tareen
- Institute of Clinical Research India (ICRI), Bangalore, India
| | | | - Mayurathan Kesavan
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Ahsan Kahn
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Nikhil Nalluri
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Hafiz M. Khan
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Dhaval Pau
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Jeffrey Abergel
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Liliane Deeb
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Sherif Andrawes
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Ananya Das
- St. Joseph Hospital Medical center, Phoenix, Arizona, USA/Arizona Center for Digestive health, Gastroenterology, Gilbert, Arizona, United States
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Mok SRS, Ho HC, Gaughan JP, Elfant AB. Therapeutic Endoscopy Can Be Performed Safely in an Ambulatory Surgical Center: A Multicenter, Prospective Study. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2016; 2016:7168280. [PMID: 27840569 PMCID: PMC5093287 DOI: 10.1155/2016/7168280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 12/27/2022]
Abstract
Background. Even amongst experienced endoscopists, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound with fine needle aspiration (EUS-FNA) carry a potential risk for complications. These procedures are typically performed in a hospital-based endoscopy unit with general anesthesia. Aims. The goal of our study was to evaluate the feasibility of ERCP and EUS-FNA in an ambulatory surgical center (ASC). Methods. From June to November of 2014, we prospectively enrolled consecutive subjects undergoing ERCP and/or EUS-FNA in an ASC. An anesthesiologist, who was not involved in our study group, screened all subjects prior to their scheduled procedure. In order to monitor for adverse events (AE), all subjects received a telephone call at day 1 and 30 days after procedure. Results. 375 subjects (98 inpatients and 277 from an ASC) were enrolled. In the total population, a high proportion of subjects underwent procedures for neoplasms (21 (23.3%) inpatients versus 44 (17.1%) from an ASC) and for sphincter of Oddi dysfunction (SOD) (27 (27.5%) versus 48 (17.3%)) and had the American Society for Anesthesiologists (ASA) class ≥III (75 (76.5%) versus 140 (50.5%)) and high-risk features (17 (17.3%) versus 75 (27.1%)). Overall ERCP-related AE (10 (13.2%) versus 12 (7.5%), p = 0.2), pancreatitis (7 (9.2%) versus 11 (6.9%), p = 0.6), and hemorrhage (3.9% versus 0.6%, p = 0.25) were not different between inpatients and ASC subjects. There was also no difference between inpatients and ASC subjects' EUS-related AE (1 (4.5%) versus 4 (3.4%), p = 0.6), pancreatitis (1 (4.5%) versus 3 (2.6%), p = 0.2), and hemorrhage (0% versus 1 (0.9%), p = 0.9). Conclusions. ERCP and EUS can be performed in a higher risk population under the supervision of anesthesia in ASCs. Overall, the AE are equivalent between inpatients and ASC subjects.
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Affiliation(s)
- Shaffer R. S. Mok
- Division of Gastroenterology and Liver Diseases, Department of Medicine, Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, Mount Laurel, NJ, USA
| | - Henry C. Ho
- Division of Gastroenterology and Liver Diseases, Department of Medicine, Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, Mount Laurel, NJ, USA
| | - John P. Gaughan
- Division of Gastroenterology and Liver Diseases, Department of Medicine, Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, Mount Laurel, NJ, USA
| | - Adam B. Elfant
- Division of Gastroenterology and Liver Diseases, Department of Medicine, Cooper Medical School of Rowan University, MD Anderson Cancer Center at Cooper, Mount Laurel, NJ, USA
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Tohda G, Ohtani M, Dochin M. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly. World J Gastroenterol 2016; 22:8382-8388. [PMID: 27729744 PMCID: PMC5055868 DOI: 10.3748/wjg.v22.i37.8382] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/08/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with acute cholangitis.
METHODS From June 2008 to May 2016, emergency ERCPs were performed in 207 cases of acute cholangitis at our institution. Patients were classified as elderly if they were aged 80 years and older (n = 102); controls were under the age of 80 years (n = 105). The patients’ medical records were retrospectively reviewed for comorbidities, laboratory data, etiology of cholangitis (presence of biliary stones, biliary stricture and malignancy), details of the ERCP (therapeutic approaches, technical success rates, procedure duration), ERCP-related complications and mortality.
RESULTS The frequency of comorbidities was higher in the elderly group than the control group (91.2% vs 67.6%). Periampullary diverticulum was observed in the elderly group at a higher frequency than the control group (24.5% vs 13.3%). Between the groups, there was no significant difference in the technical success rates (95.1% vs 95.2%) or endoscopic procedure durations. With regard to the frequency of ERCP-related complications, there was no significant difference between the two groups (6.9% vs 6.7%), except for a lower rate of post-ERCP pancreatitis in the elderly group than in the control group (1.0% vs 3.8%). Neither angiographic nor surgical intervention was required in any of the cases with ERCP-related complications. There was no mortality during the observational periods.
CONCLUSION Emergency ERCP for acute cholangitis can be performed safely even in elderly patients aged 80 years and older.
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Clark CJ, Coe A, Fino NF, Pawa R. Endoscopic retrograde cholangiopancreatography in octogenarians: A population-based study using the nationwide inpatient sample. Endosc Int Open 2016; 4:E624-30. [PMID: 27556068 PMCID: PMC4993882 DOI: 10.1055/s-0042-105432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/07/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND STUDY AIMS In the elderly population, there is a growing demand for minimally invasive procedures as the incidence of pancreaticobiliary disease increases with age. Patients with advanced age offer unique challenges for any procedure because they also tend to have a higher rate of baseline comorbidities and malignancy. The aim of the current study was to characterize the mortality and length of stay of octogenarians undergoing inpatient endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS Using the 2007 - 2010 Nationwide Inpatient Sample (NIS), we performed a retrospective analysis of health-related outcomes among 80- to 89-year-old patients undergoing inpatient ERCP. Surgical patients were excluded. RESULTS An estimated 61,322 octogenarians underwent inpatient ERCP in the United States from 2007 to 2010. The mean age was 84.2 (SE 0.02) with 59.5 % (n = 36,460) of the patients being female. A large majority of the patients were white (79. %, n = 41,144) and 63.5 % (n = 38,940) had a comorbidity index of at least 2. The mean length of stay was 7.1 days (SE 0.08) with an in-hospital mortality of 3.1 % (n = 1,919). The primary discharge diagnosis was most often biliary stone disease (55.9 %, n = 34,263). A diagnosis of any infection was recorded in 45.0 % (n = 27,609) of patients. Infection was associated with a significantly higher risk of in-hospital mortality (OR 3.3, 95 % CI 2.6 - 4.2, P < 0.001). CONCLUSIONS ERCP is now routinely being performed during inpatient admissions for octogenarians with diseases of the biliary tract. The mortality of octogenarians undergoing inpatient ERCP is higher than previous reports and is likely due to superimposed infection during the same admission.
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Affiliation(s)
- Clancy J. Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
| | - Adam Coe
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
| | - Nora F. Fino
- Division of Public Health Sciences, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
| | - Rishi Pawa
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
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Clark CJ, Fino NF, Clark N, Rosales A, Mishra G, Pawa R. Trends in the Use of Endoscopic Retrograde Cholangiopancreatography for the Management of Chronic Pancreatitis in the United States. J Clin Gastroenterol 2016; 50:417-22. [PMID: 26890329 PMCID: PMC4824658 DOI: 10.1097/mcg.0000000000000493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
GOALS The aim of this study was to characterize current trends in the use of endoscopic retrograde cholangiopancreatography (ERCP) in the United States for patients hospitalized with chronic pancreatitis. BACKGROUND Historically, ERCP was the primary tool for diagnostic and therapeutic management of chronic pancreatitis. With increased availability of magnetic resonance imaging and endoscopic ultrasound, indications for ERCP are being redefined. STUDY We performed a retrospective cohort study using the Nationwide Inpatient Sample from 1998 to 2010. We identified patients with a primary discharge diagnosis of chronic pancreatitis who underwent ERCP. We excluded patients diagnosed with biliary, gallbladder, or pancreatic neoplasm and patients who underwent gallbladder or pancreatic operation during the same admission. We analyzed patient and hospital characteristics, length of stay, and in-hospital mortality, and adjusted for weighted sample schema. RESULTS During the study period, 29,318 patients with chronic pancreatitis (mean age 52 y, 57.2% female) underwent ERCP during their hospitalization. The majority of patients were white (56.1%). The majority of procedures were performed at large (72.4%), urban (95.2%), and academic (69.0%) hospitals. Mean hospital charges were $32,929 (SE= $1605). Mean length of stay was 6 days (SE=0.3), with in-hospital mortality of 0.76%. Over the study period, the number of procedures has decreased significantly (P<0.001). CONCLUSIONS In the United States, ERCP has been an important diagnostic and therapeutic tool for chronic pancreatitis. Over the last decade, ERCP has become an uncommon inpatient procedure for chronic pancreatitis.
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Affiliation(s)
- Clancy J. Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health
| | - Nora F. Fino
- Division of Public Health Sciences, Wake Forest Baptist Health,
| | - Norman Clark
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health,
| | | | - Girsh Mishra
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health,
| | - Rishi Pawa
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health,
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Finkelmeier F, Tal A, Ajouaou M, Filmann N, Zeuzem S, Waidmann O, Albert J. ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis. Gastrointest Endosc 2015; 82:1051-9. [PMID: 26089104 DOI: 10.1016/j.gie.2015.04.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/26/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The continually increasing life expectancy in man comes along with an increasing number of endoscopic interventions performed in patients with advanced or even very advanced age. Data on the feasibility and safety of ERCP in elderly patients are relatively scarce. METHODS By a systematic query of the University Hospital Frankfurt clinical database, patients undergoing their first ERCP procedure at our center were retrospectively identified. Patients were grouped according to age at the day of the intervention (>80 years, 61-80 years, 40-60 years, and <40 years). Demographic data, indication, outcome, and risk factors were compared among the indicated groups. RESULTS A total of 758 patients who underwent ERCP procedures at our center were identified and included in the study. Main indications for ERCP were intraductal gallstones in 345 patients (45%) and tumor obstruction of the bile ducts (distal common bile duct: n = 126 [16.5%], hilar cholangiocarcinoma: n = 89 [11.7%], tumor of papilla of Vater: n = 16 [2.1%]). Gallstones were the most common cause for ERCP in patients aged >80 years (53.8%), and normal findings indicating exclusion of relevant disease were more frequent in patients <80 years (13.4%) compared with older patients (4.3%) (P < .01). Sedation adverse events were significantly more common in individuals aged >80 years compared with younger patients (3.4% vs 0.5%; P < .01). However, post-ERCP pancreatitis was significantly less frequent in the older patients (>80 years) (0.9% vs 5.3%; P < .05). Other adverse events were equally distributed in all age groups. The ERCP success rate (>80%) was not different among age groups. CONCLUSIONS ERCP is safe and efficient in patients aged 80 years or older. However, conscious sedation must be carefully monitored in older patients because risk of sedation adverse events is increased. The incidence of post-ERCP pancreatitis is lower in older patients compared with younger ones.
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Affiliation(s)
- Fabian Finkelmeier
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Andrea Tal
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Mariam Ajouaou
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Math Modeling, Faculty of Medicine, J.W. Goethe University, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Oliver Waidmann
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Jörg Albert
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
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A prospective randomized controlled study of endoscopic sphincterotomy with the Endocut mode or conventional blended cut mode. J Clin Gastroenterol 2015; 49:127-31. [PMID: 24583745 PMCID: PMC4292865 DOI: 10.1097/mcg.0000000000000096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although the potential advantages of the Endocut mode (E-mode) of endoscopic sphincterotomy (EST) over the conventional blended cut mode (C-mode) have been reported, the problems, including the small sample size and retrospective analysis, that occurred in previous studies make it difficult to conclude the advantage of the E-mode regarding the safety and efficacy. We performed a prospective randomized controlled study to compare these modes. METHODS A total of 360 patients with choledocholithiasis or stenosis of the bile duct were randomly assigned to one of the modes. To avoid the technical bias due to multiple operators or institutions, the main operator and the institution were restricted to only one experienced doctor and 3 institutions at his place of employment, respectively. We defined pancreatitis, bleeding, and perforation as complications of EST. Besides, bleeding includes endoscopically evident bleeding that was defined as visible during the procedure of sphincterotomy and temporary slight oozing. RESULTS The complications occurred in 20 (11.2%) patients from the E-mode group: pancreatitis in 6 (3.4%) and endoscopically evident bleeding in 14 (7.8%). In contrast, the complications occurred in 25 (13.8%) patients from the C-mode group: pancreatitis in 7 (3.9%) and endoscopically evident bleeding in 18 (9.9%), although these findings were not statistically significant. Overall, there were no severe complications. There were no significant differences in completion ratio of EST and the time taken for the sphincterotomy between both groups. CONCLUSIONS The E-mode could not surpass the C-mode in safety and efficacy under the operation by a single endoscopist.
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Park TY, Choi JS, Oh HC, Kim JW, Do JH, Jung YH. Assessment of safety of non-anesthesiologist-assisted endoscopic retrograde cholangiopancreatography based on performance status in elderly patients. J Gastroenterol Hepatol 2014; 29:1943-8. [PMID: 24730577 DOI: 10.1111/jgh.12608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in the elderly patients, yet little is known concerning objective criteria of safety. This study aimed to determine the potential predictors for the procedure-related outcomes. METHODS Two hundred eighty-one patients older than 70 years who were indicated for ERCP (group A [n = 195], 70-79 years of age; group B [n = 86], ≥ 80 years of age) were prospectively enrolled and analyzed for the development of serious adverse events related to ERCP. RESULTS ERCP was not performed in six patients at high risk for the procedure. There were significant differences between group A and B in Duke Activity Status Index (DASI) (23.1 vs 14.9, P < 0.01) and Eastern Cooperative Oncology Group performance status (3 and 4, 49/195 vs 33/86, P < 0.05). Major ERCP-related complications (hypotension, severe bradycardia, hypoxia, myocardial infarction, cerebral infarction) occurred in five patients from group B and three from group A. Post-ERCP pancreatitis occurred in one patient from group A and bleeding in one from group B. In univariate analysis, old age (≥ 80 years), American Society of Anesthesiologists score ≥ 3, and DASI < 10 were statistically significant predictors for overall serious events related to ERCP. In the multivariate analysis, DASI < 10 (only manage to ambulate) was independent predictor for overall serious events related to ERCP. CONCLUSION DASI score is useful predictor for the feasibility assessment of safe ERCP in the elderly patients.
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Affiliation(s)
- Tae Young Park
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea
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Chawla S, Willingham FF. Cardiopulmonary complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med 2014; 30:133-47. [PMID: 24267608 DOI: 10.1016/j.cger.2013.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There has been limited research examining the risks, benefits, and use of common endoscopic procedures in the elderly. Furthermore, gastroenterology training programs do not routinely incorporate elderly concerns when dealing with common gastrointestinal issues. There exists a broad array of endoscopic procedures with varying inherent risks that must be weighed with each elderly patient in mind. This article discusses the benefits and drawbacks of the most common procedures and indications for endoscopy including upper endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, percutaneous endoscopic gastrostomy, and deep enteroscopy.
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Affiliation(s)
- Farid Razavi
- Division of Gastroenterology, Langone Medical Center, New York University, 550 1st Avenue, New York, NY 10016, USA.
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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; 8:552-6. [PMID: 25228977 PMCID: PMC4164253 DOI: 10.5009/gnl13310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 09/30/2013] [Accepted: 10/15/2013] [Indexed: 12/15/2022] Open
Abstract
Background/Aims This case-control study evaluated the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in patients 90 years of age and older. Methods From January 2005 to August 2011, 5,070 cases of ERCP were performed at our institution. Of these, 43 cases involved patients 90 years of age and older (mean age, 91.7±1.9 years). A control group of 129 cases (mean age, 65.7±14.8 years) was matched by the patient sex, sphincterotomy, and presence of choledocholithiasis using a propensity score. The patients’ medical records were retrospectively reviewed for comorbidity, periampullary diverticulum, urgent procedure, conscious sedation, technical success, procedure duration, ERCP-related complication, and death. Results Between the case and control groups, there was no significant difference with regard to comorbidity, periampullary diverticulum, and urgent procedure. Conscious sedation was performed significantly less in the patient group versus the control group (28 [65%] vs 119 [92%], respectively; p=0.000). There was no significant difference in the technical success, procedure duration, or ERCP-related complications. In both groups, there was no major bleeding or perforation related to ERCP. Post-ERCP pancreatitis occurred significantly less in the patient group compared to the control group (0 vs 13 [10%], respectively; p=0.004). One death occurred from respiratory arrest in the case group. Conclusions ERCP can be performed safely and successfully in patients aged 90 years and older without any significant increase in complications.
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Affiliation(s)
- Dae Young Yun
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jimin Han
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jang Seok Oh
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Keun Woo Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Im Hee Shin
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho Gak Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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Abstract
With increasing age, the incidence of both benign and malignant gastrointestinal (GI) disease rises. Endoscopic procedures are commonly performed in elderly and very elderly patients to diagnose and treat GI disorders. There are a number of issues to contemplate when considering performing an endoscopic procedure in an elderly patient, including the anticipated benefits of endoscopy as well as the increased risks associated with procedural sedation and some endoscopic procedures. This review will focus on the yield and safety of endoscopic procedures in older adults.
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Steed H. Endoscopic retrograde cholangiopancreatography in nonagenarians: a decades-long experience in a single center. J Am Geriatr Soc 2011; 59:2387-8. [PMID: 22188091 DOI: 10.1111/j.1532-5415.2011.03704.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Solà-Bonada N, de Andrés-Lázaro AM, Roca-Massa M, Bordas-Alsina JM, Codina-Jané C, Ribas-Sala J. [1.6% peppermint oil solution as intestinal spasmolytic in retrograde endoscopic cholangiopancreatography]. FARMACIA HOSPITALARIA 2011; 36:256-60. [PMID: 22137159 DOI: 10.1016/j.farma.2011.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/25/2011] [Accepted: 08/16/2011] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Intestinal peristalsis can impede explorations and interventions using retrograde endoscopic cholangiopancreatography. Systemic spasmolytics are frequently employed to reduce this phenomenon, in spite of the adverse anti-cholinergic effects they are associated with. We proposed a formula using 1.6% peppermint oil solution with local use in order to avoid these adverse side effects. METHOD We formulated a preparation of 1.6% peppermint oil solution in accordance with the medical literature. The effectiveness of the formula was evaluated in a semi-qualitative manner according to the reduction in peristalsis. RESULTS We tested two different emulgents, and polysorbate provided the best results. The pilot study carried out with 8 patients demonstrated its effectiveness and safety in reducing intestinal peristalsis. CONCLUSIONS 1.6% peppermint oil solution constitutes an effective and safe alternative to the use of systemic spasmolytics. More studies are needed with a larger sample size in order to establish its usefulness in normal clinical practice.
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Affiliation(s)
- N Solà-Bonada
- Servicio de Farmacia, Hospital Clínic, Barcelona, España.
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Endoscopic retrograde cholangiopancreatography in elderly patients. Age Ageing 1999; 351:84-90. [PMID: 10408661 DOI: 10.1016/j.amjms.2015.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/30/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND the presentation of common bile duct disease, value of investigations and treatment outcome in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were assessed. METHODOLOGY the clinical presentation, liver function tests, full blood counts, abdominal ultrasound and ERCP results were assessed retrospectively in 101 patients (59 women, 42 men; mean age 83 years, range 75-100) sequentially investigated for possible common bile duct disease. RESULTS 59 patients had common bile duct gallstones, 35 had malignant biliary obstruction (13 with co-existing common bile duct stones) and seven had other outcomes. In the malignant-alone group 68% of those who had jaundice presented painlessly compared with 24% in the gallstones-alone group; 49% of the gallstones-alone group had pain compared with 28% of the malignant group. In the gallstones-alone group 43% had atypical presentations (non-specific symptoms or painless jaundice). Non-specific symptoms were found in 19% of the gallstones-alone group but in only 5% of the malignant group. Of the patients who had common bile duct stones, 18% had pancreatic or biliary malignancy. The co-existence of gallstones and malignancy was emphasized by eight patients in whom the clinical and ultrasound diagnosis was of common bile duct stones but malignancy was detected by ERCP. The sensitivity of ultrasound was 86% for detecting dilated common bile ducts was 86%, but only 69% for diagnosing gallstones within the common bile duct and 67% for diagnosing pancreatic masses. Ultrasound and ERCP were in agreement in 60 patients (60%). Endoscopic clearance of common bile duct gallstones was successful in 53 of 54 attempts (98%). Palliative ERCP treatment was performed in 30 patients who had malignant biliary obstruction and was successful in 22 (73%); in a further four patients (13%) an endoprothesis was successfully inserted percutaneously. The commonest complication of ERCP was cholangitis (four patients); pancreatitis and biliary perforation occurred in one patient each. Twenty-two patients (63%) who had malignancy died during follow-up, the mean survival being 11.3 weeks (range 3 days-2 years). Carcinoma of the ampulla was associated with a relatively good prognosis (three patients survived 18 months or more). CONCLUSION in elderly patients, common bile duct stones often present atypically and co-existence with malignancy is not unusual; ampullary carcinoma has a relatively good prognosis and ERCP is a safe and effective procedure in the management of biliary obstruction.
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