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Endoscopy 2011; 43(2): 128-133
DOI: 10.1055/s-0030-1255934
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older

P.  Katsinelos1 , J.  Kountouras1 , G.  Chatzimavroudis1 , C.  Zavos2 , S.  Terzoudis1 , I.  Pilpilidis1 , G.  Paroutoglou1
  • 1Department of Endoscopy and Motility Unit, Central Hospital, Thessaloniki, Greece
  • 2Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece
Further Information

Publication History

submitted 9 November 2009

accepted after revision 14 September 2010

Publication Date:
24 November 2010 (online)

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Commentaire de travail de P. Katsinelos et al., pp. 128Endoscopy 2011; 43(02): 174-174
DOI: 10.1055/s-0031-1291817

Background and study aim: The aim of this observational prospective study was to evaluate the safety of outpatient therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in a very elderly cohort.

Patients and methods: A total of 600 patients were included in the study between June 2006 and June 2009. All underwent first therapeutic ERCP and were scheduled to be discharged on the same day following a postprocedure observation period of 6 hours. Of the 600 patients, 123 patients (group A) were re-admitted due to postprocedure complications that presented during the observation period, and 477 patients (group B) were discharged on the same day. Concomitant diseases, details of ERCP procedures, complications, and outcomes were all evaluated. The accuracy of the 6-hour postprocedure observation period, clinical criteria in predicting those patients aged 80 years and older in whom all therapeutic ERCP can be performed on an outpatient basis, and costs saved were all assessed.

Results: There was a statistical difference in incidence of concomitant diseases between groups A and B (group A 84.5 % vs. group B 74.6 %; P = 0.020). However, there was no difference between the groups with regard to indication for ERCP and type of intervention. There was no difference in postprocedure complication rate between very elderly patients and younger patients (< 80 years), except for prolonged sedation or hypotension, which occurred more frequently in older (≥ 80 years) than in younger (< 80 years) patients (7.6 % vs. 3.2 %; P = 0.037). In group B, complications necessitating re-admission after the 6-hour observation period occurred in 10 patients (2.09 %) (patients ≥ 80 years 0.8 % and patients < 80 years 2.5 %). The costs saved by performing the procedure on an outpatient basis was calculated as 150  € per patient.

Conclusion: Outpatient therapeutic ERCP with postprocedure observation of 6 hours is a safe and cost-effective procedure in a significant proportion of very elderly patients.

References

  • 1 Ross S O, Forsmark C E. Pancreatic and biliary disorders in the elderly.  Gastroenterol Clin North Am. 2001;  30 531-534
    CrossrefPubMedGoogle Scholar
  • 2 Vandervoort J, Soetikno R M, Tham T C et al. Risk factors for complications after performance of ERCP.  Gastrointest Endosc. 2002;  56 652-656
    CrossrefPubMedGoogle Scholar
  • 3 Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older.  Gastrointest Endosc. 2000;  52 187-191
    CrossrefPubMedGoogle Scholar
  • 4 Rodríguez-González F J, Naranjo-Rodríguez A, Mata-Tapia I et al. ERCP in patients 90 years of age and older.  Gastrointest Endosc. 2003;  58 220-225
    CrossrefPubMedGoogle Scholar
  • 5 Mitchell R M, O’Connor F, Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older.  J Clin Gastroenterol. 2003;  36 72-74
    CrossrefPubMedGoogle Scholar
  • 6 Hui C K, Liu C L, Lai K C et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older.  Aliment Pharmacol Ther. 2004;  19 1153-1158
    CrossrefPubMedGoogle Scholar
  • 7 Katsinelos P, Paroutoglou G, Kountouras J et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older.  Gastrointest Endosc. 2006;  63 417-423
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Podolsky I, Kortan P, Haber G B. Endoscopic sphincterotomy in outpatients.  Gastrointest Endosc. 1989;  35 372-376
    CrossrefPubMedGoogle Scholar
  • 10 Elfant A B, Bourke M J, Alhalel R et al. A prospective study of the safety of endoscopic therapy for choledocholithiasis in an outpatient population.  Am J Gastroenterol. 1996;  91 1499-1502
    PubMedGoogle Scholar
  • 11 Mehta S N, Pavone E, Barkun A N. Outpatient therapeutic ERCP: a series of 262 consecutive cases.  Gastrointest Endosc. 1996;  44 443-449
    CrossrefPubMedGoogle Scholar
  • 12 Duncan H D, Hodgkinson L, Deakin M, Green J R. The safety of diagnostic and therapeutic ERCP as a daycase procedure with a selective admission policy.  Eur J Gastroenterol Hepatol. 1997;  9 905-908
    PubMedGoogle Scholar
  • 13 Tham T C, Vandervoort J, Wong R C et al. Therapeutic ERCP in outpatients.  Gastrointest Endosc. 1997;  45 225-230
    CrossrefPubMedGoogle Scholar
  • 14 Cvetkovski B, Gerdes H, Kurtz R C. Outpatient therapeutic ERCP with endobiliary stent placement for malignant common bile duct obstruction.  Gastrointest Endosc. 1999;  50 63-66
    CrossrefPubMedGoogle Scholar
  • 15 Ho K Y, Montes H, Sossenheimer M J et al. Features that may predict hospital admission following outpatient therapeutic ERCP.  Gastrointest Endosc. 1999;  49 587-592
    CrossrefPubMedGoogle Scholar
  • 16 Freeman M L, Nelson D B, Sherman S et al. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group.  Gastrointest Endosc. 1999;  49 580-586
    CrossrefPubMedGoogle Scholar
  • 17 Fox C J, Harry R A, Cairns S R. A prospective series of out-patient endoscopic retrograde cholangiopancreatography.  Eur J Gastroenterol Hepatol. 2000;  12 523-527
    CrossrefPubMedGoogle Scholar
  • 18 Hui C K, Lai K C, Wong W M et al. Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: six-hour versus overnight observation.  J Gastroenterol Hepatol. 2004;  19 1163-1168
    CrossrefPubMedGoogle Scholar
  • 19 Mahnke D, Chen Y K, Antillon M R et al. A prospective study of complications of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in an ambulatory endoscopy center.  Clin Gastroenterol Hepatol. 2006;  4 924-930
    CrossrefPubMedGoogle Scholar
  • 20 Cotton P B, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
    CrossrefPubMedGoogle Scholar
  • 21 Masci E, Toti G, Mariani A et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study.  Am J Gastroenterol. 2001;  96 417-423
    CrossrefPubMedGoogle Scholar
  • 22 Freeman M L. Adverse outcomes of ERCP.  Gastrointest Endosc. 2002;  56 (Suppl. 6) S273-S282
    CrossrefPubMedGoogle Scholar
  • 23 Freeman M L, DiSario J A, Nelson D B et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study.  Gastrointest Endosc. 2001;  54 425-434
    CrossrefPubMedGoogle Scholar
  • 24 Jeurnink S, Poley J W, Steyerberg E W et al. ERCP as an outpatient treatment: a review.  Gastrointest Endosc. 2008;  68 118-123
    CrossrefPubMedGoogle Scholar
  • 25 Pfau P R. Outpatient ERCP – everybody is doing it: does this make it right?.  Gastrointest Endosc. 2008;  68 124-126
    CrossrefPubMedGoogle Scholar
  • 26 Hussain N, Alsulaiman R, Burtin P et al. The safety of endoscopic sphincterotomy in patients receiving antiplatelet agents: a case-control study.  Aliment Pharmacol Ther. 2007;  25 579-584
    CrossrefPubMedGoogle Scholar
  • 27 Eisen G M, Baron T H, Dominitz J A et al. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures.  Gastrointest Endosc. 2002;  55 775-779
    CrossrefPubMedGoogle Scholar

P. KatsinelosMD, PhD 

Department of Endoscopy and Motility Unit
Central Hospital

Ethnikis Aminis 41
546 35, Thessaloniki
Greece

Fax: +30-2310-210401

Email: gchatzimav@yahoo.gr

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