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

Year 2020, Volume: 28 Issue: Sayı: 3, 101 - 106, 30.12.2020

Mustafa Kaplan Bülent Ödemiş Selçuk Dişibeyaz Volkan Gökbulut Orhan Coşkun Adem Aksoy

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.

Keywords

Geriatri, safra kanalı taşları, endoskopik retrograd kolanjiyopankreatografi

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

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.

Keywords

Geriatrics, bile duct stones, endoscopic retrograde cholangiopancreatography

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