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85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği

Year 2020, Volume: 28 Issue: Sayı: 3, 101 - 106, 30.12.2020
https://doi.org/10.17940/endoskopi.832354

Abstract

Giriş ve Amaç: Bu çalışmada 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografinin endikasyonları, bulguları, başarısı ve komplikasyonları araştırıldı. Gereç ve Yöntem: Bu çalışmada 2015-2019 yılları arasında endoskopik retrograd kolanjiyopankreatografi yapılan hastaların kayıtları incelenmiş ve çalışma 85 yaş üzeri 289 hasta ile yapılmıştır. Bulgular: Çalışma 169 kadın (%58) ve 120 erkek (%42) olmak üzere toplam 289 hasta ile yapılmıştır. Hastaların ortalama yaşı 88 idi (85-108). Endoskopik retrograd kolanjiyopankreatografinin en sık endikasyonları izole karaciğer enzim yüksekliği (%39), kolanjit (%32) ve karaciğer enzim yüksekliği olmaksızın karın ağrısıydı (%21). Hastaların %66’sına yatırılarak, %87.2’sine sadece tek seans endoskopik retrograd kolanjiyopankreatografi yapılmıştı. Hastaların %28’inde divertikül mevcuttu ve %25’i sfinkterotomiliydi. Hastaların %99’u ilk seansta, tamamı ise ikinci seansta kanülize edildi. 241 hastada selektif (%83), 48 hastada precut (%16) yöntemi kullanıldı. En sık endoskopik retrograd kolanjiyopankreatografi bulguları koledok taşı (%71) ve malign biliyer darlıktı (%12). En sık görülen maligniteler ise pankreas kanseri (%38) ve kolanjiyokanserdi (%32). Taş çıkanlarda teknik başarı %99, malign hastalarda ise %100 idi. Çalışmamızda en sık görülen komplikasyonlar post-endoskopik retrograd kolanjiyopankreatografi pankreatiti (%5.8) ve kanama (%2) idi. Bir hastada tip 1 perforasyon gelişti ve hasta exitus oldu. Üç yıllık takipte mortalite oranı %26 iken 30 günlük mortalite oranı %8 olarak bulunmuştur. Sonuç: Eşlik eden kronik hastalıklara rağmen, 85 yaş ve üstü hastalarda endoskopik retrograd kolanjiyopankreatografi güvenli ve etkili bir tedavi yöntemidir.

References

  • 1. Pitkälä KH, Martin FC, Maggi S, Jyväkorpi SK, Strandberg TE. Status of Geriatrics in 22 Countries. J Nutr Health Aging 2018;22:627-31.
  • 2. Corrigan LR, Bracken-Clarke DM, Horgan AM. The challenge of treating older patients with pancreaticobiliary malignancies. Curr Probl Cancer 2018;42:59-72.
  • 3. Han SJ, Lee TH, Kang BI, et al. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years. Dig Dis Sci 2016;61:2094-101.
  • 4. Yang JH, Li W, Si XK, Zhang JX, Cao YJ. Efficacy and safety of therapeutic ERCP in the elderly: A single center experience. Surg Laparosc Endosc Percutan Tech 2018;28:e44-8.
  • 5. Guda NM, Reddy DN, Kumar A. Complications of ERCP. Indian J Gastroenterol 2014;33:1-9.
  • 6. Lukens FJ, Howell DA, Upender S, Sheth SG, Jafri SM. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci 2010;55:847-51.
  • 7. Kalaitzakis E. All-cause mortality after ERCP. Endoscopy 2016;48:987-94.
  • 8. Saito H, Koga T, Sakaguchi M, et al. Safety and efficacy of endoscopic removal of common bile duct stones in elderly patients ≥90 years of age. Intern Med 2019;58:2125-32.
  • 9. Owens WD, Felts JA, Spitznagel EL. ASA physical status classificationsdstudy of consistency of ratings. Anesthesiology 1978;49:239-43.
  • 10. Garcia CJ, Lopez OA, Islam S, et al. Endoscopic retrograde cholangiopancreatography in the elderly. Am J Med Sci 2016;351:84-90.
  • 11. Köklü S, Parlak E, Yüksel O, Sahin B. Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study. Age Ageing 2005;34:572-7.
  • 12. Kim JE, Cha BH, Lee SH, et al. Safety and efficacy of endoscopic retrograde cholangiopancreatograpy in very elderly patients. Korean J Gastroenterol 2011;57:237-42.
  • 13. Galeazzi M, Mazzola P, Valcarcel B, et al. Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians' point of view. BMC Gastroenterol 2018;18:38.
  • 14. Baydar B, Serin A, Vatansever S, et al. Safety of endoscopic retrograde cholangiopancreatography in patients 80 years of age and older. Prz Gastroenterol 2014;9:227-31.
  • 15. Murata A, Motomura Y, Akahoshi K, et al. Therapeutic ERCP for choledocholithiasis in patients 80 years of age and older. J Clin Gastroenterol 2009;43:289-90.
  • 16. Bill JG, Mullady DK. Stenting for benign and malignant biliary strictures. Gastrointest Endosc Clin N Am 2019;29:215-35.
  • 17. Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 2006;64:899-905.
  • 18. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP; a prospective multicenter study. Am J Gastroenterol 2001;96:417-23.
  • 19. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP; a prospective multicenter study. Gastrointest Endosc 1998;48:1-10
  • 20. Søreide JA, Karlsen LN, Sandblom G, Enochsson L. Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review. Surg Endosc 2019;33:1731-48.

Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients aged ≥85 years

Year 2020, Volume: 28 Issue: Sayı: 3, 101 - 106, 30.12.2020
https://doi.org/10.17940/endoskopi.832354

Abstract

Background and Aims: We investigated the indications, findings, and success and complication rates using endoscopic retrograde cholangiopancreatography in patients aged ≥85 years. Materials and Methods: The study included 289 patients aged ≥85 years. The records of patients who had undergone endoscopic retrograde cholangiopancreatography between 2015 and 2019 were examined. Results: The study population included 169 females (58%) and 120 males (42%) with a mean age of 88 years (range, 85-108 years). The most common indications for endoscopic retrograde cholangiopancreatography were isolated liver enzyme level elevation (39%), cholangitis (32%), and abdominal pain without elevated liver enzyme levels (21%). Of the total, 66% patients were hospitalized and 87.2% patients required only 1 endoscopic retrograde cholangiopancreatography session. Diverticulum was present in 28% patients, and 25% had prior sphincterotomy. Cannulation in the first session was performed for 99% patients and in the second session for the remaining. Of the total, selective method was used in 241 patients (83%) and precut method in 48 patients (16%). The most common endoscopic retrograde cholangiopancreatography findings included choledochal stone (71%) and malignant biliary stenosis (12%). The most common malignancies included pancreatic cancer (38%) and cholangiocarcinoma (32%). A 99% technical success was achieved in patients with stone, which was 100% in patients with malignancy. The most common complications included post- endoscopic retrograde cholangiopancreatography pancreatitis (5.8%) and bleeding (2%). One patient experienced type 1 perforation and died. The 30-day mortality rate was 8%, which increased to 26% at the 3-year follow-up. Conclusion: Despite concomitant chronic diseases, endoscopic retrograde cholangiopancreatography is a safe and effective treatment for patients aged ≥85 years.

References

  • 1. Pitkälä KH, Martin FC, Maggi S, Jyväkorpi SK, Strandberg TE. Status of Geriatrics in 22 Countries. J Nutr Health Aging 2018;22:627-31.
  • 2. Corrigan LR, Bracken-Clarke DM, Horgan AM. The challenge of treating older patients with pancreaticobiliary malignancies. Curr Probl Cancer 2018;42:59-72.
  • 3. Han SJ, Lee TH, Kang BI, et al. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years. Dig Dis Sci 2016;61:2094-101.
  • 4. Yang JH, Li W, Si XK, Zhang JX, Cao YJ. Efficacy and safety of therapeutic ERCP in the elderly: A single center experience. Surg Laparosc Endosc Percutan Tech 2018;28:e44-8.
  • 5. Guda NM, Reddy DN, Kumar A. Complications of ERCP. Indian J Gastroenterol 2014;33:1-9.
  • 6. Lukens FJ, Howell DA, Upender S, Sheth SG, Jafri SM. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci 2010;55:847-51.
  • 7. Kalaitzakis E. All-cause mortality after ERCP. Endoscopy 2016;48:987-94.
  • 8. Saito H, Koga T, Sakaguchi M, et al. Safety and efficacy of endoscopic removal of common bile duct stones in elderly patients ≥90 years of age. Intern Med 2019;58:2125-32.
  • 9. Owens WD, Felts JA, Spitznagel EL. ASA physical status classificationsdstudy of consistency of ratings. Anesthesiology 1978;49:239-43.
  • 10. Garcia CJ, Lopez OA, Islam S, et al. Endoscopic retrograde cholangiopancreatography in the elderly. Am J Med Sci 2016;351:84-90.
  • 11. Köklü S, Parlak E, Yüksel O, Sahin B. Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study. Age Ageing 2005;34:572-7.
  • 12. Kim JE, Cha BH, Lee SH, et al. Safety and efficacy of endoscopic retrograde cholangiopancreatograpy in very elderly patients. Korean J Gastroenterol 2011;57:237-42.
  • 13. Galeazzi M, Mazzola P, Valcarcel B, et al. Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians' point of view. BMC Gastroenterol 2018;18:38.
  • 14. Baydar B, Serin A, Vatansever S, et al. Safety of endoscopic retrograde cholangiopancreatography in patients 80 years of age and older. Prz Gastroenterol 2014;9:227-31.
  • 15. Murata A, Motomura Y, Akahoshi K, et al. Therapeutic ERCP for choledocholithiasis in patients 80 years of age and older. J Clin Gastroenterol 2009;43:289-90.
  • 16. Bill JG, Mullady DK. Stenting for benign and malignant biliary strictures. Gastrointest Endosc Clin N Am 2019;29:215-35.
  • 17. Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 2006;64:899-905.
  • 18. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP; a prospective multicenter study. Am J Gastroenterol 2001;96:417-23.
  • 19. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP; a prospective multicenter study. Gastrointest Endosc 1998;48:1-10
  • 20. Søreide JA, Karlsen LN, Sandblom G, Enochsson L. Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review. Surg Endosc 2019;33:1731-48.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Mustafa Kaplan This is me 0000-0002-6959-675X

Bülent Ödemiş This is me 0000-0002-3914-7531

Selçuk Dişibeyaz This is me 0000-0002-1637-7684

Volkan Gökbulut This is me 0000-0002-7906-2479

Orhan Coşkun This is me 0000-0002-3124-9517

Adem Aksoy This is me 0000-0003-3823-3654

Publication Date December 30, 2020
Published in Issue Year 2020 Volume: 28 Issue: Sayı: 3

Cite

APA Kaplan, M., Ödemiş, B., Dişibeyaz, S., Gökbulut, V., et al. (2020). 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği. Endoskopi Gastrointestinal, 28(Sayı: 3), 101-106. https://doi.org/10.17940/endoskopi.832354
AMA Kaplan M, Ödemiş B, Dişibeyaz S, Gökbulut V, Coşkun O, Aksoy A. 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği. Endoskopi Gastrointestinal. December 2020;28(Sayı: 3):101-106. doi:10.17940/endoskopi.832354
Chicago Kaplan, Mustafa, Bülent Ödemiş, Selçuk Dişibeyaz, Volkan Gökbulut, Orhan Coşkun, and Adem Aksoy. “85 Yaş üstü Hastalarda Endoskopik Retrograd kolanjiyopankreatografi’nin etkinliği Ve güvenilirliği”. Endoskopi Gastrointestinal 28, no. Sayı: 3 (December 2020): 101-6. https://doi.org/10.17940/endoskopi.832354.
EndNote Kaplan M, Ödemiş B, Dişibeyaz S, Gökbulut V, Coşkun O, Aksoy A (December 1, 2020) 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği. Endoskopi Gastrointestinal 28 Sayı: 3 101–106.
IEEE M. Kaplan, B. Ödemiş, S. Dişibeyaz, V. Gökbulut, O. Coşkun, and A. Aksoy, “85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği”, Endoskopi Gastrointestinal, vol. 28, no. Sayı: 3, pp. 101–106, 2020, doi: 10.17940/endoskopi.832354.
ISNAD Kaplan, Mustafa et al. “85 Yaş üstü Hastalarda Endoskopik Retrograd kolanjiyopankreatografi’nin etkinliği Ve güvenilirliği”. Endoskopi Gastrointestinal 28/Sayı: 3 (December 2020), 101-106. https://doi.org/10.17940/endoskopi.832354.
JAMA Kaplan M, Ödemiş B, Dişibeyaz S, Gökbulut V, Coşkun O, Aksoy A. 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği. Endoskopi Gastrointestinal. 2020;28:101–106.
MLA Kaplan, Mustafa et al. “85 Yaş üstü Hastalarda Endoskopik Retrograd kolanjiyopankreatografi’nin etkinliği Ve güvenilirliği”. Endoskopi Gastrointestinal, vol. 28, no. Sayı: 3, 2020, pp. 101-6, doi:10.17940/endoskopi.832354.
Vancouver Kaplan M, Ödemiş B, Dişibeyaz S, Gökbulut V, Coşkun O, Aksoy A. 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği. Endoskopi Gastrointestinal. 2020;28(Sayı: 3):101-6.