title: Short-acting general anaesthesia facilitates therapeutic ERCP in frail elderly patients with benign extra-hepatic biliary disease.
abstract: OBJECTIVE
  To ascertain whether therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for benign biliary disease in frail elderly patients with comorbid conditions can be safely undertaken in a district general hospital, and whether the procedure is facilitated by the use of short-acting general anaesthesia.
  
  
  METHODS
  District general hospital in South East England.
  
  
  METHODS
  Clinical study of 25 consecutive patients with benign biliary disease.
  
  
  METHODS
  Describes the process of bile duct clearance by therapeutic ERCP under short-acting general anaesthesia in 25 patients with co-morbidity aged > or = 80 years and gives details of the general anaesthesia and monitoring.
  
  
  RESULTS
  Twenty-two patients had their bile ducts successfully cleared locally and one patient was stented for a benign biliary stricture. The ampullae of two other patients were lying within diverticula, which hindered cannulation and only pancreatograms were obtained; one of the patients had a successful bile duct clearance at a tertiary centre, the other refused further intervention. Complications (melaena, bronchopneumonia and a Clostridium difficile infection) occurred in two patients (8%). There was no morbidity associated with the anaesthesia, and no mortality occurred within 30 days of the procedure.
  
  
  CONCLUSIONS
  Bile duct clearance by therapeutic ERCP can be safely carried out in frail elderly patients in a district general hospital and the process is facilitated by the use of short-acting general anaesthesia. The importance of optimizing the patient's condition before ERCP, and not overfilling the pancreatic duct, is highlighted.
authors.affiliation: Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals NHS Trust, Margate, UK.
authors.forename: J B
authors.initials: JB
authors.lastname: Cocking
authors.forename: A
authors.initials: A
authors.lastname: Ferguson
authors.forename: S K
authors.initials: SK
authors.lastname: Mukherjee
authors.forename: G
authors.initials: G
authors.lastname: Giancola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001649:Bile Duct Diseases / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D015607:Stents; D013997:Time Factors