老年患者接受内镜逆行胰胆管造影术的不良事件：一项系统评价和荟萃分析。
Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis.
作者信息
Day Lukejohn W, Lin Lisa, Somsouk Ma
机构信息
Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, United States ; GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California, United States.
Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States.
出版信息
Endosc Int Open. 2014 Mar;2(1):E28-36. doi: 10.1055/s-0034-1365281. Epub 2014 Mar 7.
BACKGROUND AND STUDY AIMS
Biliary and pancreatic diseases are common in the elderly; however, few studies have addressed the occurrence of adverse events in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Our objective was to determine the incidence rates of specific adverse events in this group and calculate incidence rate ratios (IRRs) for selected comparison groups.
PATIENTS AND METHODS
Bibliographical searches were conducted in Medline, EMBASE, and Cochrane library databases. The studies included documented the incidence of adverse events (perforation, pancreatitis, bleeding, cholangitis, cardiopulmonary adverse events, mortality) in patients aged ≥ 65 who underwent ERCP. Pooled incidence rates were calculated for each reported adverse event and IRRs were determined for available comparison groups. A parallel analysis was performed in patients aged ≥ 80 and ≥ 90.
RESULTS
Our literature search yielded 7429 articles, of which 69 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 ERCPs) in patients aged ≥ 65 were as follows: perforation 3.8 (95 %CI 1.8 - 7.0), pancreatitis 13.1 (95 %CI 11.0 - 15.5), bleeding 7.7 (95 %CI 5.7 - 10.1), cholangitis 16.1 (95 %CI 11.7 - 21.7), cardiopulmonary events 3.7 (95 %CI 1.5 - 7.6), and death 7.1 (95 %CI 5.2 - 9.4). Patients ≥ 65 had lower rates of pancreatitis (IRR 0.3, 95 %CI 0.3 - 0.4) compared with younger patients. Octogenarians had higher rates of death (IRR 2.4, 95 %CI 1.3 - 4.5) compared with younger patients, whereas nonagenarians had increased rates of bleeding (IRR 2.4, 95 %CI 1.1 - 5.2), cardiopulmonary events (IRR 3.7, 95 %CI 1.0 - 13.9), and death (IRR 3.8, 95 %CI 1.0 - 14.4). Conclusions ERCP appears to be safe in elderly patients, except in the very elderly who are at higher risk of some adverse events. These data on adverse event rates can help to inform clinical decision-making, the consent process, and comparative effectiveness analyses.
背景与研究目的
胆胰疾病在老年人中很常见；然而，很少有研究探讨接受内镜逆行胰胆管造影术（ERCP）的老年患者不良事件的发生情况。我们的目的是确定该组特定不良事件的发生率，并计算选定比较组的发生率比值（IRR）。
患者与方法
在Medline、EMBASE和Cochrane图书馆数据库中进行文献检索。纳入的研究记录了年龄≥65岁接受ERCP患者的不良事件（穿孔、胰腺炎、出血、胆管炎、心肺不良事件、死亡率）发生率。计算每个报告的不良事件的合并发生率，并确定可用比较组的IRR。对年龄≥80岁和≥90岁的患者进行了平行分析。
结果
我们的文献检索得到7429篇文章，其中69项研究符合我们的纳入标准。年龄≥65岁患者不良事件的合并发生率（每1000例ERCP）如下：穿孔3.8（95%CI 1.8 - 7.0），胰腺炎13.1（95%CI 11.0 - 15.5），出血7.7（95%CI 5.7 - 10.1），胆管炎16.1（95%CI 11.7 - 21.7），心肺事件3.7（95%CI 1.5 - 7.6），死亡7.1（95%CI 5.2 - 9.4）。与年轻患者相比，≥65岁患者的胰腺炎发生率较低（IRR 0.3，95%CI 0.3 - 0.4）。与年轻患者相比，八旬老人的死亡率较高（IRR 2.4，95%CI 1.3 - 4.
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