How Does Aging Affect Presentation and Management of Biliary Stones?
Common bile duct (CBD) stones are common in elderly adults, but the effect of aging on the presentation of CBD stones remains to be evaluated. Recent studies have demonstrated that the clinical presentation of CBD stones may vary with age. Younger adults may present with classical biliary colic symptoms, whereas elderly adults may have no unapparent clinical features. Younger adults with CBD stones were significantly more likely to have abnormal liver function tests than those without. The sensitivity and accuracy of transabdominal ultrasound scans in screening for CBD stones increases with age. Antibiotic agents should be promptly administered to individuals with CBD stones complicated by cholangitis, but the effects of pharmacotherapy on renal function should be considered in elderly adults. Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be first-line treatment for CBD stones, and endoscopic biliary sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) along with ERCP is an adequate biliary drainage method in individuals with CBD stones. EPBD has a lower bleeding risk but higher post-ERCP risk of pancreatitis than EST. Longer-duration (>1 minute) EPBD may be preferred over EST because it is associated with a comparable risk of pancreatitis but a lower rate of overall complications, although recurrent cholangitis or unfavorable outcomes will increase during CBD dilation or in the presence of residual CBD stones.
Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.|Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.|MacKay Medical, Nursing, and Management College, Taipei, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Kuang-Chun
KC
Hu
Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.|MacKay Medical, Nursing, and Management College, Taipei, Taiwan.
Cheng-Hsin
CH
Chu
Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.|MacKay Medical, Nursing, and Management College, Taipei, Taiwan.
Horng-Yuan
HY
Wang
Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.|MacKay Medical, Nursing, and Management College, Taipei, Taiwan.
Wen-Hsiung
WH
Chang
Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.|MacKay Medical, Nursing, and Management College, Taipei, Taiwan.
Shee-Chan
SC
Lin
Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.
Chuan-Chuan
CC
Liu
Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Wei-Chih
WC
Liao
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chun-Jen
CJ
Liu
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ming-Shiang
MS
Wu
Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.|Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.|MacKay Medical, Nursing, and Management College, Taipei, Taiwan.|MacKay Medical College, Taipei, Taiwan.
Shou-Chuan
SC
Shih
D000368:Aged; D000375:Aging; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000601:surgery*; D015577:Geriatric Assessment; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D011379:Prognosis; D016717:Sphincterotomy, Endoscopic
D000900:Anti-Bacterial Agents
biliary stone disease; effects of aging; elderly; management; presentation