Clinical success of ERCP procedures in nonagenarian patients with bile duct stones

Abstract

In the general population, endoscopic retrograde cholangiopancreatography (ERCP) procedures are the gold standard in the treatment of bile duct stones. However, repeat endoscopic procedures and sometimes even open surgery are needed in difficult cases with retaining bile duct stones. The aim of the present study was to determine the clinical success of ERCP procedures in the treatment of bile duct stones in extremely old patients. A retrospective data review comprising prospective data collection and double-entry bookkeeping of 23 therapeutic ERCPs in 20 nonagenarians with bile duct stones was conducted between 1997 and 2007. The primary ERCP procedure was the definitive treatment in 17 out of 20 patients with bile duct stones, giving a clinical success rate of 85 % for the first endoscopic procedure. In the remaining three patients, a repeat ERCP procedure had to be done in the follow-up. After these three repeat procedures with successful outcome, the clinical success of endoscopic treatment was 100%. There was no further recurrent biliary obstruction in any of the patients prior to death which occurred after a mean of 38 months (two patients are still alive), and no open surgery had to be performed in these patients. To be concluded, endoscopic treatment modality seems to be excellent in extremely elderly patients with bile duct stones.