Endoscopic Treatment For The Elderly With Bile Duct Stones: Is It Useful And Safe As Well As For Younger Patients?

Purpose: The incidence of elderly patients (80 years old or older) with common bile duct (CBD) stones is increasing due to the aging society. Because of the high risk of complications such as cholangitis or acute pancreatitis, the removal of CBD stones should be recommended. On the other hand, the high morbidity of the elderly is another serious problem. This study is designed to clarify the characteristics of the elderly with CBD stones and evaluate the usefulness of endoscopic treatment. Methods: In this study, we retrospectively analyzed 235 available cases with CBD stones between April 2000 and September 2006. All patients were divided into 80 years old or older (the elder group: 87 cases) and less than 80 years old (the younger group: 148 cases). First, we assessed characteristics of patients included abnormalities in liver function tests, the maximum size of stones, emergency or scheduled endoscopic examination, presence of mentally and/or physically challenged conditions, anticoagulants use and past history of gastrectomy in each group. Then we compared the success rate and complications of endoscopic treatment in the elder group with those in the younger group. Results: The incidence of abnormalities in liver function test was 90.8% in the elder group and 89.2% in the younger group. The maximum size of stones was divided into three groups: 5 mm or less, from 6 to10 mm and 11 mm or more. The incidence of each group was 20.7%, 36.8% and 42.5% in the elder group, and 33.8%, 43.9%, 22.3% in the younger group. The maximum size of stones in the elder group tended to be larger than that of the younger group. The incidence of emergency endoscopic examination and mentally and/or physically challenged condition in the elder group (48.3%, 64.4%) were statistically higher than those of the younger group (35.8%, 16.2%). The incidences of anticoagulants use and the history of gastrectomy didn't show any statistical difference between either group. The success rate of endoscopic treatment (98.9%) and the complete removal of stones (96.6%) in the elder group didn't show any statistical difference between those in the younger group (98.0% and 93.2%). The incidences of complications included bleeding, pancreatitis and perforation were 5.81%, 4.65% and 3.49% in the elder group, and didn't show any statistical difference than those in the younger group (8.22%, 6.85% and 0.68%). Conclusions: Though the incidences of emergency endoscopic examination and mentally and/or physically challenged conditions were statistically higher in older patients with CBD stones, the endoscopic treatment for the elderly is safe and useful just as for younger patients.