Feasibility of therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones in nonagenarians: a single unit audit

Abstract

Background: Little information is available on short and long-term outcome of therapeutic endoscopic retrograde colangiopancreatography (ERCP) for choledocholithiasis in nonagenarians (>=90 years). The aim of this study was to evaluate retrospectively the feasibility of therapeutic ERCP in nonagenarians with choledocholithiasis, as compared with patients aged between 75 and 89 years.

Patients and methods: During a 9-year period, therapeutic ERCP was performed for choledocholithiasis in 33 nonagenarian patients (group A) and 272 patients aged 75 to 89 years (group B). Clinical features, endoscopic findings, interventions, early and long-term results of therapeutic ERCP for a mean follow-up of 36 months were assessed and compared between the two groups.

Results: Group A patients had a higher incidence of acute cholangitis, concomitant diseases and gallbladder stones, as compared to group B patients. Furthermore, they required an emergency procedure, multiple sessions, stent insertion, and needle knife fistulotomy significantly more frequently (p<0.001). Group B patients underwent significantly more endoscopic manipulations and had a longer procedure time than group A patients. Complete bile duct stone clearance was achieved in 24.2% of group A patients and in 90.8% of group B patients (p<0.001). No ERCP related deaths occurred in group A patients. Cholecystectomy was not routinely performed in Group A patients having gallbladder stones. The rate of early and late complications was not significantly different between the two age groups.

Conclusion: Therapeutic ERCP and biliary stenting have proved to be a feasible treatment option for the management of choledocholithiasis in nonagenarians.