TREATMENT OF ACUTE CHOLANGITIS DUE TO CHOLEDOCHOLITHIASIS IN ELDERLY AND YOUNGER PATIENTS

Objective: To evaluate management strategies for acute cholangitis in elderly patients (age, greater than or equal to 80 years). Design: Non randomized control trial. Setting: A university hospital. Patients: Pa tients (n=191) who underwent urgent biliary drainage for acute cholang itis due to choledocholithiasis. Thirty-seven patients were elderly, a nd 154 were younger (age, <80 years). Interventions: Surgical (8 elder ly and 48 younger patients), percutaneous transhepatic (11 elderly and 47 younger patients), or endoscopic drainage (18 elderly and 59 young er patients). Main Outcome Measures: Clinical features of acute cholan gitis and outcomes of biliary drainage. Results: The elderly patients had higher incidences of septic shock or mental confusion (acute sever e cholangitis) (43.2%) and concomitant diseases (81.1%) than the young er patients (25.3% and 42.9%, respectively). The elderly patients had significantly greater morbidity (37.8%) and mortality (10.8%), compare d with the younger patients (16.9% and 3.2%, respectively). Mortality was 18.8% in elderly patients with severe cholangitis and 4.8% in thos e with nonsevere cholangitis. In the elderly patients, endoscopic drai nage yielded lower morbidity (16.7%) and mortality (5.6%) than surgica l (87.5% and 25.0%, respectively) and percutaneous drainage (36.4% and 9.1%, respectively). No complications occurred after endoscopic nasob iliary drainage without sphincterotomy. Conclusions: Elderly patients with acute cholangitis have high incidence of severe disease and conco mitant medical problems. They should undergo endoscopic biliary draina ge, especially nasobiliary drainage without sphincterotomy, because of its safety and effectiveness.