Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older.
BACKGROUND
Little information is available on the outcomes of endoscopic sphincterotomy for choledocholithiasis in patients of advanced age (>/=90 years).


METHODS
Endoscopic sphincterotomy was performed for choledocholithiasis in 22 patients aged 90 years or more (group A) and 381 aged 70 to 89 years (group B). Clinical features and early outcomes of endoscopic sphincterotomy were compared between the two groups. In group A, long-term results for a mean follow-up period of 33 months were assessed.


RESULTS
Group A patients had a higher incidence of symptoms, acute cholangitis and concomitant diseases, as well as larger and more numerous gallstones than did group B patients. Endoscopic sphincterotomy was technically successful in 100% of group A patients and 98% of group B patients. The rate of early complications was low in both groups: 5% in group A and 7% in group B. No deaths related to endoscopic retrograde cholangiopancreatography occurred in group A patients. Complete stone clearance was achieved in 86% of group A patients and 95% of group B patients. Group A required an emergency procedure, general anesthesia, multiple sessions, mechanical lithotripsy, and permanent biliary stent placement more frequently than group B. Late complications occurred in 5% of group A patients.


CONCLUSIONS
Endoscopic sphincterotomy is safe and effective for the treatment of choledocholithiasis in patients 90 years of age or older. Biliary stent placement is a reasonable alternative treatment when stones prove to be difficult to extract.
First Department of Surgery, Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan.
M
M
Sugiyama
Y
Y
Atomi
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome