Gp. Deenitchin et al., REAPPRAISAL OF SAFETY OF ENDOSCOPIC SPHINCTEROTOMY FOR COMMON BILE-DUCT STONES IN THE ELDERLY, The American journal of surgery, 170(1), 1995, pp. 51-54
BACKGROUND: Endoscopic sphincterotomy is the method of choice for elde
rly patients with common bile duct stones, even though these patients
are poor operative risks, We undertook this study to analyze the opera
tive risk factors for this age group, METHODS: We compared specific pr
oblems of 182 patients aged 80 years or older and 921 younger patients
who underwent endoscopic sphincterotomy for common bile duct stones.
RESULTS: Despite a higher frequency of periampullary diverticula in th
e elderly than in the younger patients (54% versus 36%, P <0.001), the
success rates of sphincterotomy were not different, The elderly patie
nts required lithotripsy more often than did the younger ones (15% ver
sus 4%, P <0.001), and the necessity of stenting or nasobiliary draina
ge was greater in this group (9%) than in the younger group (5%, P <0.
05), This difference in the tactics between the older and younger grou
ps was due to the greater number and size of stones, longer period of
time for complete clearance of the common bile duct (13.5 versus 6.0 d
ays, P <0.01), and a greater percentage of patients with operative ris
ks (55% versus 36%, P <0.001). The elderly also had significantly grea
ter overall morbidity compared with the younger patients (13% versus 7
%, P <0.005), frequency of acute cholangitis (8% versus 2%, P <0.001),
and mortality (1% versus O%), CONCLUSION: These results suggest that
frequent stenting or nasobiliary drainage to prevent cholangitis or pr
ompt stone removal by lithotripsy would be necessary in this group of
patients.