Efficacy and safety of endoscopic papillary large balloon dilation for large bile duct stones in elderly patients.
BACKGROUND
Minimally invasive interventions for choledocholithiasis are preferable in elderly patients because they tend to have multiple underlying disorders or a decreased activity of daily living. Endoscopic sphincterotomy and endoscopic papillary balloon dilation have been recognized as first-line treatments for choledocholithiasis excluding difficult cases such as large stones or multiple stones. Recently, the safety and efficacy of endoscopic papillary large balloon dilation (EPLBD) for difficult choledocholithiasis cases have been reported, although scarcely in elderly patients.


OBJECTIVE
To investigate whether EPLBD can be safety and effectively performed in patients aged 75 years or older.


METHODS
The medical records of 165 patients who underwent EPLBD from November 2006 to August 2013 were analyzed retrospectively. The patients were divided into 2 groups: Group A (≥ 75 years); Group B (<75 years).


RESULTS
Some underlying diseases were significantly more common in Group A than in Group B (P < 0.05). However, there was no significant difference in the success rates in the first session (96.2 vs 95.0 %, P = 0.970) and in the final success rates (100 % in both groups) between Group A and Group B. The adverse event rates (2.9 vs 5.0 %, P = 0.783) and recurrence rates of choledocholithiasis (6.7 vs 10.0 %, P = 0.444) were not significantly different. Regarding patients with an altered anatomy, the EPLBD outcome was not significantly different.


CONCLUSIONS
EPLBD can be safely performed for elderly patients similarly to younger patients.
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, tonozuka1978@gmail.com.
Ryosuke
R
Tonozuka
Takao
T
Itoi
Atsushi
A
Sofuni
Fumihide
F
Itokawa
Toshio
T
Kurihara
Takayoshi
T
Tsuchiya
Kentaro
K
Ishii
Shujiro
S
Tsuji
Nobuhito
N
Ikeuchi
Junko
J
Umeda
Reina
R
Tanaka
Mitsuyoshi
M
Honjyo
Shuntaro
S
Mukai
Mitsuru
M
Fujita
Fuminori
F
Moriyasu
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome