Endoscopic management of acute cholangitis in elderly patients

Table 1 Demographic and clinical characteristics of patients with severe acute cholangitis

	Group I	Group II
n	123	52
Mean age ± SD (range ) years	38.6 ± 12.4 (20-56)	68.4 ± 10.8a (60-90)
Gender (Male: Female)	72:51	33:19
Clinical presentation n (%)
Right upper	116 (94.3)	27 (52)a
Quadrant pain	118 (96)	18 (34.6)a
Fever ≥ 38.0°C	2 (1.6)	20 (38.4)a
< 38.0°C	120 (97.5)	48 (92.3)
Jaundice	3 (2.4)	19 (36.5)a
Altered sensorium	5 (4.0)	13 (25.0)a
Hypotension	22 (17.8)	14 (11.3)a
Peritonism	5 (4.0)	14 (11.3)a
Renal failure	4 (3.2)	21 (40.3)a
Other systemic illnesses

^aP < 0.05.

Table 2 Etiology and site of biliary obstruction in common bile duct

Etiology of biliary obstruction	Site of biliary obstruction	Group In = 123(%)	Group IIn = 52(%)
Benign causes (n = 138)
Common bile duct stone	Lower	104 (84.5)	18 (34.6)a
Chronic pancreatitis	Lower	2 (1.6)	0
Post operative biliary stricture	Upper	7 (5.7)	0
Hydatid cyst rupture with fistula	Upper	4 (3.2)	0
Rupture liver abscess with fistula	Upper	3 (2.4)	0
Malignant causes (n = 37)
Gallbladder carcinoma	Upper	2 (1.6)	14 (27)a
Cholangiocacinoma	Upper + middle	0	5 (9.6)a
Periampullary carcinoma	Lower	1 (0.8)	15 (28.8)a

^aP < 0.05.

Table 3 Laboratory parameters before endoscopic biliary drainage (mean ± SD)

	Group I(n = 123)	Group II(n = 52)	P
Total leucocyte count, × 109/L	28.6 ± 6.4	20.4 ± 4.6	< 0.01
Total bilirubin, mg/dL	12.4 ± 8.2	20.6 ± 10.4	< 0.01
Aspartate aminotransferase, IU/L	62 ± 24	58 ± 20.6	NS
Alanine aminotransferase, IU/L	52 ± 18.4	56 ± 14.4	NS
Alkaline phosphatase, IU/L	402 ± 196	1126 ± 644	< 0.01
Serum albumin, g/dL	3.6 ± 0.8	3.8 ± 0.8	NS

Table 4 Indications of biliary drainage

Indication	Group In = 123 (%)	Group IIn = 52 (%)	P
Fever ≥ 38.0°C	118 (96)	18 (34.6)	< 0.01
Hypotension	5 (4)	13 (25)	< 0.01
Peritonism	22 (18)	14 (26.9)	< 0.01
Altered sensorium	3 (2.6)	19 (36.5)	< 0.01
Failure to improve with conservative management	2 (1.6)	20 (38.4)	< 0.01

Table 5 Clinical characteristics, indications and results of biliary drainage in patients with acute cholangitis due to stones in common bile duct (n = 122)

	Group In = 104 (%)	Group IIn = 18 (%)	P
Clinical parameters
Fever	102 (98)	10 (55.5)	< 0.01
Jaundice	101 (97.1)	14 (77.7)	< 0.01
Altered sensorium	1 (0.96)	8 (44.4)	< 0.01
Hypotension	1 (0.96)	5 (27.8)	< 0.01
Peritonism	12 (11.5)	6 (33.3)	< 0.01
Renal failure	3 (2.8)	7 (38.9)	< 0.01
Indications of biliary drainage
Fever ≥ 38.0°C	102 (98)	6 (33.3)	< 0.01
Hypotension	1 (0.96)	5 (27.8)	< 0.01
Peritonism	12 (11.5)	6 (33.3)	< 0.01
Altered sensorium	1 (0.96)	8 (44.4)	< 0.01
Failure to improve with conservative treatment	1 (0.96)	7 (38.9)	< 0.01
Results of biliary drainage
Time taken for improvement
Median (range) days	5 (2-15)	10 (3-20)	< 0.01
Mortality	0	2	< 0.01
Length of hospital stay
Mean (range) days	8.2 (7-20)	16.4 (7-30)	< 0.01