Endoscopic retrograde cholangiopancreatography in the elderly:: a prospective and comparative study
Endoscopic retrograde cholangiopancreatography in the elderly:: a prospective and comparative study
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DOI：
10.1093/ageing/afi180
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发表时间：
2005-11-01
期刊：
影响因子：
6.7
通讯作者：
Sahin, B
中科院分区：
文献类型：
--
作者：
Köklü, S;Parlak, E;Sahin, B
目的：在这项研究中，我们旨在比较内窥镜逆行胰胆管造影（ERCP）在老年人和年轻人中的有效性和安全性。方法：本研究纳入2002年3月至2003年1月299例首次行ERCP的患者。A组包括202名69岁及以下的患者，B组包括97名70岁及以上的患者。前瞻性地确定患者并收集他们的前瞻性数据。比较两组患者的临床生化特征、ERCP程序、ERCP诊断、并发症及住院时间。结果：与a组相比，B组患者表现出更具体的症状。两组的实验室检查结果相似，但胆红素平均水平在老年组较高。两组患者选择性胆道插管成功率均达99%。A组和B组分别有49.5%和56.7%的患者行预切乳头切开术。胆总管结石是两组中最常见的诊断。A组以良性胆道狭窄多见，b组以恶性胆道狭窄多见。恶性病因中，两组以胰腺癌多见。27例（9%）患者出现术后并发症。202例70岁以下患者发生并发症16例（7.9%），其中出血6例，胰腺炎5例，穿孔3例，胆管炎2例。相比之下，97例70岁以上患者中有11例（11.3%）出现并发症（6例出血，1例胰腺炎，1例穿孔，2例胆管炎，1例肠梗阻）。12例患者（A组9例，B组3例）在手术后5-30天内死亡。两组住院时间相当（A组15.53 +/- 12.43天，B组14.84 +/- 11.56天）。结论：诊断性和治疗性ERCP在老年和年轻患者中具有相似的结果。ERCP治疗老年乳突患者是安全有效的。更有侵入性的手术，如预切乳头切开术，可以安全地在老年人中进行。
Objective: in this study we aimed to compare the utility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly and younger groups of people.Methods: the study involved 299 patients who underwent ERCP for the first time between March 2002 and January 2003. Group A consisted of 202 patients who were 69 years of age or younger and group B involved 97 patients who were 70 years of age or older. The patients were prospectively identified and data were gathered on them prospectively. Clinical and biochemical features, ERCP procedures, ERCP diagnosis, complications and length of hospital stay were compared between the two groups.Results: group B patients presented with more specific symptoms compared with group A. Laboratory findings were similar in both groups other than mean bilirubin levels, which were higher in the elderly group. Selective biliary cannulation was technically successful in 99% of both groups. Precut papillotomy was performed in 49.5% of group A patients and 56.7% of group B patients. Choledocholithiasis was the most frequent diagnosis in both groups. Benign biliary stenosis was more frequent in group A and malignant biliary stenosis in group B. Among the malignant aetiologies, pancreatic carcinoma was the most common cancer in both groups. Post-procedural complications developed in 27 (9%) patients. There were 16 (7.9%) complications (six bleeding, five pancreatitis, three perforation and two cholangitis) in the 202 patients aged under 70 years. In comparison, 11 (11.3%) of the 97 patients aged over 70 years developed a complication (bleeding in six, pancreatitis in one, perforation in one, cholangitis in two and ileus in one). Twelve (nine group A and three group B) patients died within 5-30 days of the procedure. Length of hospital stay was comparable for both groups (15.53 +/- 12.43 days in group A and 14.84 +/- 11.56 days in group B).Conclusions: diagnostic and therapeutic ERCP has similar outcomes in both elderly and younger patients. ERCP is effective and safe in elderly patients with naive papilla. The more invasive procedures like precut papillotomy may be performed safely in the elderly.