Difficult biliary stones in the elderly: Endoscopic retrograde cholangiography – A single surgical tertiary centre experience with follow-up

• Main Authors: Pavlos Antypas, Fabrizio Cereatti, Fausto Fiocca, Annalisa Cappello, Chiara Eberspacher, Gianfranco Fanello, Domenico Mascagni, Gianfranco Donatelli
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Journal of Minimal Access Surgery
• Subjects: difficult biliary stones; elderly; endoscopic treatment; recurrence; therapeutic endoscopic retrograde cholangiopancreatography
• Online Access: http://www.journalofmas.com/article.asp?issn=0972-9941;year=2021;volume=17;issue=4;spage=502;epage=508;aulast=Antypas

Background: Pancreaticobiliary diseases and choledocholithiasis are common in elderly patients. Endoscopic treatment of biliary stones represents a well-established mini-invasive technique. However, limited data are available regarding the treatment of 'difficult' biliary stones, especially in the elderly population. The aim of our study is to evaluate the efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients ≥85 years of age with complex biliary stones. Materials and Methods: From January 2015 to January 2017, data from ERCP procedures performed for complex biliary stones were retrospectively collected. The patients were divided into two groups based on their age: Group A – aged 85 years or older (n = 110) and Group B – aged 65 years or younger (n = 62). Demographic data, success, complications and recurrence rates for both groups were reported. Results: Chronic comorbidities (86.3% vs. 24.2%; P < 0.001) and use of antithrombotic drugs (48.2% vs. 19.3%; P < 0.001) were more frequent in the elderly. The technical success rate (95.4% vs. 96.7%; P > 0.6) and complication rate (8.2% vs. 13%; P > 0.2) were not statistically different among the two groups. Periampullary diverticula (PAD) were observed more frequently in Group A (38.1% vs. 17.7%; P < 0.006). More patients from Group B underwent cholecystectomy during the same admission (8.2% vs. 42.3%; P < 0.001). The recurrence rate was not different among the groups (7.6% vs. 5%; P > 0.5). PAD was identified as the risk factor for recurrence (P < 0.02). Conclusion: ERCP in the elderly was found to be a safe procedure, carrying a high degree of success for the treatment of difficult biliary stones.