Hakuta Ryunosuke, Kogure Hirofumi, Nakai Yousuke, Hamada Tsuyoshi, Sato Tatsuya, Suzuki Yukari, Inokuma Akiyuki, Kanai Sachiko, Nakamura Tomoka, Noguchi Kensaku, Ishigaki Kazunaga, Saito Kei, Saito Tomotaka, Takahara Naminatsu, Mizuno Suguru, Yamada Atsuo, Tada Minoru, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
Endosc Int Open. 2020 Sep;8(9):E1202-E1211. doi: 10.1055/a-1216-1363. Epub 2020 Aug 31.
Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74-2.51; = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, = 0.20). BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.
对于解剖结构已手术改变的患者，内镜逆行胰胆管造影术（ERCP）具有挑战性。最近，气囊内镜已被证明可促进该人群的ERCP，技术成功率高，但不良事件（AE）并不少见。与非老年患者相比，老年患者由于潜在的合并症，发生AE的风险可能更高。本研究旨在评估气囊内镜辅助ERCP（BE-ERCP）用于老年患者的可行性。我们回顾性确定了2010年1月至2019年9月期间接受BE-ERCP的患者。对于在研究期间接受多次手术的患者，分析第一次手术情况。比较老年（≥75岁）和非老年患者与BE-ERCP相关的早期AE。共进行了1363例BE-ERCP手术，纳入568例患者（211例老年患者和357例非老年患者）进行分析。老年组和非老年组的技术成功率均较高（分别为80%和80%）。两组之间早期AE的发生率相似（老年组和非老年组分别为12%和9.0%；P = 0.31）。老年患者与非老年患者相比，早期AE的多变量调整优势比为1.36（95%置信区间，0.74-2.51；P = 0.32）。具体而言，我们未观察到两组之间在胃肠道穿孔发生率（老年组和非老年组分别为2.4%和2.8%；P = 0.99）和吸入性肺炎发生率（1.9%对0.6%，P = 0.20）方面的差异。BE-ERCP对于解剖结构已手术改变的老年个体是一种可行的手术。
