Interval percutaneous cholecystostomy is effective for decompression of the common bile duct in high-risk elderly patients prior to endoscopic retrograde cholangiopancreatography.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for common bile duct decompression. Nevertheless, this procedure may be hazardous for high-risk elderly patients.


OBJECTIVE
To assess retrospectively whether interval percutaneous cholecystostomy (PC) should be considered in high-risk patients until their condition has improved and allows ERCP to be performed.


METHODS
Referral community teaching hospital.


METHODS
8 elderly high-risk patients with acute cholangitis.


METHODS
All underwent PC as a bridging procedure till performing ERCP.


RESULTS
Age ranged from 72 to 91 years (median 87). All 8 patients underwent PC. PC insertion improved their general condition and allowed us to perform an ERCP later on. Median time between PC and ERCP was 5 days. In 3 patients there was no need to perform an ERCP. All were discharged in a generally good condition and after normalization of bilirubin and liver enzymes. Median length of stay in hospital was 18 days.


CONCLUSIONS
PC, as a bridging procedure to ERCP, can be an appropriate approach for selective high-risk elderly patients in whom ERCP is considered to be difficult and hazardous at the time of presentation.
Shitrit
Ariella Bar-Gil
AB
Department of Gastroenterology, Shaare-Zedek Medical Center, Jerusalem, Israel. davariel@zahav.net.il
Braverman
Dan
D
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D015331:Cohort Studies; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome