Background: the presentation of common bile duct disease, value of investig
ations and treatment outcome in elderly patients undergoing endoscopic retr
ograde cholangiopancreatography (ERCP) were assessed.
Methodology: the clinical presentation, liver function tests, full blood co
unts, abdominal ultrasound and ERCP results were assessed retrospectively i
n 101 patients (59 women, 42 men; mean age 83 years, range 75-100) sequenti
ally investigated for possible common bile duct disease.
Results: 59 patients had common bile duct gallstones, 35 had malignant bili
ary obstruction (13 with co-existing common bile duct stones) and seven had
other outcomes. In the malignant-alone group 68% of those who had jaundice
presented painlessly compared with 24% in the gallstones-alone group; 49%
of the gallstones-alone group had pain compared with 28% of the malignant g
roup. In the gallstones-alone group 43% had atypical presentations (non-spe
cific symptoms or painless jaundice), Non-specific symptoms were found in 1
9% of the gallstones-alone group bur in only 5% of the malignant group. Of
the patients who had common bile duct stones, 18% had pancreatic or biliary
malignancy The co-existence of gallstones and malignancy was emphasized by
eight patients in whom the clinical and ultrasound diagnosis was of common
bile duct stones but malignancy was detected by ERCP. The sensitivity of u
ltrasound was 86% for detecting dilated common bile ducts was 86%, but only
69% for diagnosing gallstones within the common bile duct and 67% for diag
nosing pancreatic masses. Ultrasound and ERCP were in agreement in 60 patie
nts (60%). Endoscopic clearance of common bile duct gallstones was successf
ul in 53 of 54 attempts (98%), Palliative ERCP treatment was performed in 3
0 patients who had malignant biliary obstruction and was successful in 22 (
73%); in a further four patients (13%) an endoprothesis was successfully in
serted percutaneously. The commonest complication of ERCP was cholangitis (
four patients); pancreatitis and biliary perforation occurred in one patien
t each. Twenty-two patients (63%) who had malignancy died during follow-up,
the mean survival being 11.3 weeks (range 3 days-2 years), Carcinoma of th
e ampulla was associated with a relatively good prognosis (three patients s
urvived 18 months or more).
Conclusion: in elderly patients, common bile duct stones often present atyp
ically and co-existence with malignancy is not unusual; ampullary carcinoma
has a relatively good prognosis and ERCP is a safe and effective procedure
in the management of biliary obstruction.