title: Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients.
abstract: BACKGROUND
  Acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients.
  
  
  METHODS
  We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Patients' demographics, severity grading, methods and timing of biliary drainage, mortality, and hospital stay were retrospectively obtained from medical records. Clinical parameters and outcomes were compared between elderly (75-80 years, n=156) and very elderly (≥81 years, n=175) patients. We analyzed the effects of methods [none, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage, or failure] and timing (urgent or early) of biliary drainage on mortality and hospital stay in these patients.
  
  
  RESULTS
  Acute cholangitis in older patients manifested as atypical symptoms characterized as infrequent Charcot's triad (4.2%) and comorbidity in one-third of the patients. Patients were graded as mild, moderate, and severe cholangitis in 104 (31.4%), 175 (52.9%), and 52 (15.7%), respectively. Urgent biliary drainage (≤24 hours) was performed for 80.5% (247/307) of patients. Very elderly patients tended to have more severe grades and were treated with sequential procedures of transient biliary drainage and stone removal at different sessions. Hospital stay was related to methods and timing of biliary drainage. Mortality was very low (1.5%) and not related to patient age but rather to the success or failure of biliary drainage and severity grading of the acute cholangitis.
  
  
  CONCLUSIONS
  The methods and timing used for biliary drainage and severity of cholangitis are the major determinants of mortality and hospital stay in elderly and very elderly patients with acute cholangitis. Urgent successful ERCP is mandatory for favorable prognosis in these patients.
authors.affiliation: Department of Internal Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea. smpark@chungbuk.ac.kr.
authors.forename: Chan Sun
authors.initials: CS
authors.lastname: Park
authors.forename: Hee Seok
authors.initials: HS
authors.lastname: Jeong
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Kim
authors.forename: Joung-Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Hee Bok
authors.initials: HB
authors.lastname: Chae
authors.forename: Sei Jin
authors.initials: SJ
authors.lastname: Youn
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000401:mortality; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome