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

Yıl 2020, , 101 - 106, 30.12.2020
https://doi.org/10.17940/endoskopi.832354

Öz

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.

Kaynakça

  • 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

Yıl 2020, , 101 - 106, 30.12.2020
https://doi.org/10.17940/endoskopi.832354

Öz

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.

Kaynakça

  • 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.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Mustafa Kaplan Bu kişi benim 0000-0002-6959-675X

Bülent Ödemiş Bu kişi benim 0000-0002-3914-7531

Selçuk Dişibeyaz Bu kişi benim 0000-0002-1637-7684

Volkan Gökbulut Bu kişi benim 0000-0002-7906-2479

Orhan Coşkun Bu kişi benim 0000-0002-3124-9517

Adem Aksoy Bu kişi benim 0000-0003-3823-3654

Yayımlanma Tarihi 30 Aralık 2020
Yayımlandığı Sayı Yıl 2020

Kaynak Göster

APA Kaplan, M., Ödemiş, B., Dişibeyaz, S., Gökbulut, V., vd. (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. Aralık 2020;28(Sayı: 3):101-106. doi:10.17940/endoskopi.832354
Chicago Kaplan, Mustafa, Bülent Ödemiş, Selçuk Dişibeyaz, Volkan Gökbulut, Orhan Coşkun, ve Adem Aksoy. “85 Yaş üstü Hastalarda Endoskopik Retrograd kolanjiyopankreatografi’nin etkinliği Ve güvenilirliği”. Endoskopi Gastrointestinal 28, sy. Sayı: 3 (Aralık 2020): 101-6. https://doi.org/10.17940/endoskopi.832354.
EndNote Kaplan M, Ödemiş B, Dişibeyaz S, Gökbulut V, Coşkun O, Aksoy A (01 Aralık 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, ve A. Aksoy, “85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği”, Endoskopi Gastrointestinal, c. 28, sy. Sayı: 3, ss. 101–106, 2020, doi: 10.17940/endoskopi.832354.
ISNAD Kaplan, Mustafa vd. “85 Yaş üstü Hastalarda Endoskopik Retrograd kolanjiyopankreatografi’nin etkinliği Ve güvenilirliği”. Endoskopi Gastrointestinal 28/Sayı: 3 (Aralık 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 vd. “85 Yaş üstü Hastalarda Endoskopik Retrograd kolanjiyopankreatografi’nin etkinliği Ve güvenilirliği”. Endoskopi Gastrointestinal, c. 28, sy. Sayı: 3, 2020, ss. 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.