AI Article Synopsis
- The study investigates the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in older patients with a poor performance status (PS 3 or 4) who have common bile duct stones (CBDS).
- Data was collected from 1343 patients across three Japanese institutions, with a focus on comparing those with a PS of 0-2 to those with a PS of 3-4 to assess complication rates and therapeutic success.
- Results showed that while ERCP is generally effective for patients with a PS of 3-4, with similar success rates to those with better PS scores, the complication rates were higher in the poorer PS group, highlighting the need for careful consideration before proceeding with
Article Abstract
Background: As the aging population grows worldwide, the rates of endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones (CBDS) in older patients with a poor performance status (PS) have been increasing. However, the data on the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4 are lacking, with only a few studies having investigated this issue among patients with poor PS.
Aim: To examine the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4.
Methods: This study utilized a retrospective multi-centered design of three institutions in Japan for 8 years to identify a total of 1343 patients with CBDS having native papillae who underwent therapeutic ERCP. As a result, 1113 patients with a PS 0-2 and 230 patients with a PS 3-4 were included. One-to-one propensity-score matching was performed to compare the safety and efficacy of ERCP for CBDS between patients with a PS 0-2 and those with a PS 3-4.
Results: The overall ERCP-related complication rates in all patients and propensity score-matched patients with a PS 0-2 and 3-4 were 9.0% (100/1113) and 7.0% (16/230; = 0.37), and 4.6% (9/196) and 6.6% (13/196; = 0.51), respectively. In the propensity score-matched patients, complications were significantly more severe in the group with a PS 3-4 than in the group with a PS 0-2 group ( = 0.042). Risk factors for complications were indications of ERCP and absence of antibiotics in the multivariate analysis. Therapeutic success rates, including complete CBDS removal and permanent biliary stent placement, in propensity score-matched patients with a PS 0-2 and 3-4 were 97.4% (191/196) and 97.4% (191/196), respectively ( = 1.0).
Conclusion: ERCP for CBDS can be effectively performed in patients with a PS 3 or 4. Nevertheless, the indication for ERCP in such patients should be carefully considered with prophylactic antibiotics.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048491 | PMC |
| http://dx.doi.org/10.4253/wjge.v14.i4.215 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Endoscopic Papillary Large Balloon Dilatation With or Without Endoscopic Sphincterotomy in the Treatment of Common Bile Duct Stones.
Dig Dis Sci
December 2024
Department of Gastroenterology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, China.
Purpose Of Review: Endoscopic papillary large balloon dilation (EPLBD) has been proved to have better efficacy and safety in removing common bile duct stones. Conventional endoscopic sphincterotomy (EST) is usually performed before EPLBD. However, EPLBD without EST has recently reported short-term outcomes similar to those of EPLBD with EST.
View Article and Find Full Text PDFType Vb Double Common Bile Duct: A Rare Case Associated With Cholangiocarcinoma.
Cureus
September 2024
Gastroenterology, Grandview Medical Center, Birmingham, USA.
Double common bile duct (DCBD), also called extrahepatic biliary duct duplication, is a rare anatomical variation of the biliary anatomy that involves either the presence of a septum within the common bile duct (CBD) or an accessory CBD. The first case of DCBD was reported by Vesarius in 1543. A classification system for DCBD that included five types was proposed in 2007.
View Article and Find Full Text PDFTwo institutes' experience in laparoendoscopic "rendezvous" technique for patients undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct: a prospective randomized comparative clinical trial.
Updates Surg
October 2024
Assistant Professor of General Surgery, Zagazig University, Zagazig City, Egypt.
There is still disagreement on the best treatment option for cholecystocholedocholithiasis. Although there are some benefits to the single-step procedure, the "laparoendoscopic rendezvous" (LERV) technique that include a lower risk of post-ERCP pancreatitis and a shorter hospital stay, the standard technique is still the two-step approach for clearing the common bile duct (CBD) using ERCP and then performing a laparoscopic cholecystectomy. The purpose of this study was to assess the effectiveness and safety of the LERV technique vs.
View Article and Find Full Text PDFEndoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience.
Obes Surg
October 2024
Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Background: Management of biliopancreatic pathology in Roux-en-Y gastric bypass (RYGB) patients is challenging despite the availability of multiple approaches like single-balloon enteroscopy-assisted ERCP (SBE-ERCP), laparoscopy-assisted ERCP (LA-ERCP), and EUS-directed transgastric intervention (EDGI). We evaluated the outcomes of the interchangeable combination of endoscopic procedures to treat biliopancreatic pathology in RYGB patients.
Materials And Methods: This is a monocentric retrospective study of consecutive RYGB patients with biliopancreatic pathology between June 2014 and September 2023.
Objectives: Endoscopic lithotripsy and elective cholecystectomy, followed by endoscopic retrograde cholangiopancreatography, are the first-line treatments for patients with common bile duct (CBD) stones (CBDS) and gallstones. However, this approach entails acute cholecystitis and recurrent cholangitis risk while patients await surgery. We aimed to identify acute cholecystitis and cholangitis risk factors during the waiting time for elective cholecystectomy.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!