Chong V H, Yim H B, Lim C C
Gastroenterology Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA1710, Negara Brunei Darussalam.
Singapore Med J. 2005 Nov;46(11):621-6.
As the population ages, the incidence of biliary tract pathologies also increases, leading to an increase in the demand for endoscopic retrograde cholangiopancreatography (ERCP) interventions. Our aims are to assess the outcomes, safety and complications associated with ERCP performed in an elderly population.
Patients aged 80 years or over referred for ERCP from January 1999 to September 2002, were identified and retrospectively reviewed.
103 patients (68 females, mean age 84.6 +/- 3.9 years old) underwent 144 procedures (1-6 procedures/patient). The main indications were cholangitis (51.4 percent), choledocholithiasis (19.4 percent) and blocked stents (14.6 percent). Malignancies represented 5.6 percent of indications. The mean procedure time was 38 +/- 16 minutes. The overall success rate was 80.5 percent. Minor events occurred in 23 percent (tachycardia 13, desaturation six, transient hypotension six, self-limiting bleed four, extravasations three, and mild pancreatitis one). Major events were post sphincterotomy bleeding (five days post-procedure) one, duodenal perforation one (Billroth-II gastrectomy, survived after surgery), cholangitis two, and one death was probably procedure-related (acute myocardial event five days post-stenting in a patient with Klatskin tumour). Seven deaths occurred within one month of ERCP, due to advanced malignancies (four), sepsis (two) and acute myocardial infarction (one). Patients who died within one month had significantly higher serum urea (p-value equals 0.001), and creatinine (p-value equals 0.007) levels, and lower haemoglobin (p-value equals 0.014) level. More patients had an underlying malignancy (p-value less than 0.001). In addition, they were given significantly less conscious sedation (midazolam [p-value equals 0.002] and fentanyl [p-value equals 0.018]).
Our study showed that ERCP is safe in an elderly Asian population. Minor complications are usually transient and related to sedation, and mortality is usually related to severity of illness and underlying malignancies.
随着人口老龄化，胆道疾病的发病率也在上升，导致内镜逆行胰胆管造影术（ERCP）干预需求增加。我们的目的是评估老年人群中ERCP的治疗效果、安全性及并发症。
确定1999年1月至2002年9月期间因ERCP转诊的80岁及以上患者，并进行回顾性分析。
103例患者（68例女性，平均年龄84.6±3.9岁）接受了144次手术（每位患者1 - 6次手术）。主要适应证为胆管炎（51.4%）、胆总管结石（19.4%）和支架堵塞（14.6%）。恶性肿瘤占适应证的5.6%。平均手术时间为38±16分钟。总体成功率为80.5%。23%的患者发生轻微事件（心动过速19例、血氧饱和度下降6例、短暂性低血压6例、自限性出血4例、渗漏3例、轻度胰腺炎1例）。严重事件包括括约肌切开术后出血（术后5天）1例、十二指肠穿孔1例（毕罗氏Ⅱ式胃切除术，术后存活）、胆管炎2例，1例死亡可能与手术相关（肝门部胆管癌患者支架置入术后5天发生急性心肌事件）。7例患者在ERCP术后1个月内死亡，原因是晚期恶性肿瘤（4例）、败血症（2例）和急性心肌梗死（1例）。术后1个月内死亡的患者血清尿素（p值等于0.001）、肌酐（p值等于0.007）水平显著升高，血红蛋白（p值等于0.014）水平降低。合并潜在恶性肿瘤的患者更多（p值小于0.001）。此外，给予他们的清醒镇静剂（咪达唑仑[p值等于0.002]和芬太尼[p值等于0.018]）明显更少。
我们的研究表明，ERCP在亚洲老年人群中是安全的。轻微并发症通常是短暂的，与镇静有关，死亡率通常与疾病严重程度和潜在恶性肿瘤有关。
