Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly

Table 1 Clinical characteristics and laboratory data of enrolled patients

	Age≥80 yr	Age < 80 yr	P value
	(n = 102)	(n = 105)
Age (yr)	85 (81-92)	67 (58-75)	< 0.05
Sex
Male	41 (40.2)	62 (59.0)	< 0.05
Female	61 (59.8)	43 (41.0)
Fever (centigrade)	39.0 (38.5-39.3)	38.9 (38.7-39.4)	NS
WBC (103/L)	12.8 (10.4-15.2)	12.5 (10.7-14.6)	NS
Platelet (103/L)	132 (105-180)	171 (130-231)	< 0.05
Albumin (g/dL)	2.9 (2.6-3.3)	3.6 (3.4-4.0)	< 0.05
Bilirubin (mg/dL)	4.3 (3.1-6.0)	4.2 (2.8-6.7)	NS
AST (U/L)	229 (150-418)	182 (141-256)	< 0.05
ALT (U/L)	195 (128-277)	197 (144-303)	NS
ALP (U/L)	798 (576-1154)	811 (510-1175)	NS
γ-GTP (U/L)	336 (256-451)	350 (249-548)	NS
ASA
Class 2	34 (33.3)	59 (56.2)	< 0.05
Class 3	67 (65.7)	45 (42.9)
Class 4	1 (1.0)	1 (1.0)

Continuous variables are expressed as median (interquartile range; IQR), categorical variables are expressed as n (%). WBC: White blood cells; AST: Aspartate transaminase; ALT: Alanine transaminase; ALP: Alkaline phosphatase; γ-GTP: γ-glutamyl transpeptidase; ASA: American Society of Anesthesiology; NS: Not significant.

Table 2 Comorbidities of patients with acute cholangitis n (%)

	Age≥80 yr	Age < 80 yr	P value
	(n = 102)	(n = 105)
Comorbidity	93 (91.2)	71 (67.6)	< 0.05
Hypertension	80 (78.4)	53 (50.5)	< 0.05
Ischemic heart disease	40 (39.2)	18 (17.1)	< 0.05
Chronic heart failure	8 (7.8)	6 (5.7)	NS
Arrhythmia	17 (16.7)	14 (13.3)	NS
Cerebrovascular disease	30 (29.4)	10 (9.5)	< 0.05
Dementia	23 (22.5)	4 (3.8)	< 0.05
Diabetes mellitus	21 (20.6)	19 (18.1)	NS
Chronic liver disease	9 (8.8)	8 (7.6)	NS
Liver cirrhosis	3 (2.9)	3 (2.9)	NS
COPD/Asthma	15 (14.7)	7 (6.7)	< 0.05
Chronic renal failure	5 (4.9)	4 (3.8)	NS
Malignancy1	8 (7.8)	3 (2.9)	< 0.05
Periampullary diverticulum	25 (24.5)	14 (13.3)	< 0.05

¹Malignancy other than a primary biliary and pancreatic lesion. COPD: Chronic obstructive pulmonary disease; NS: Not significant.

Table 3 Etiology of acute cholangitis n (%)

	Age≥80 yr	Age < 80 yr	P value
	(n = 102)	(n = 105)
CBD stone	65 (63.7)	72 (68.6)	NS
Gallstone cholecystitis	2 (2.0)	4 (3.8)	NS
Pancreatitis	1 (1.0)	2 (1.9)	NS
Malignant obstruction	31 (30.4)	23 (21.9)	< 0.05
Pancreatic cancer	4 (3.9)	5 (4.8)	NS
Biliary cancer	21 (20.6)	11 (10.5)	< 0.05
GB cancer	3 (2.9)	4 (3.8)	NS
Other cause1	3 (2.9)	3 (2.9)	NS
Benign stricture	3 (2.9)	4 (3.8)	NS

¹Biliary obstruction caused by metastatic lymph node(s). CBD: Common bile duct; GB: Gall bladder; NS: Not significant.

Table 4 Procedural details of endoscopic retrograde cholangiopancreatography n (%)

	Age ≥ 80 yr	Age < 80 yr	P value
	(n = 102)	(n = 105)
Details of the procedure
Biliary stent insertion	97 (95.1)	100 (95.2)	NS
Endoscopic sphincterotomy	69 (67.6)	87 (82.9)	< 0.05
Complete stone removal	53/651 (81.5)	67/722 (93.1)	< 0.05
Technical success3	97 (95.1)	100 (95.2)	NS
Procedures time (min), mean ± SD	37.6 ± 8.1	40.1 ± 7.7	NS
Failed cannulation	5 (4.9)	5 (4.8)	NS

Number of patients with biliary stones in the elderly¹ and in the control² groups,

³technical success is defined as an endoscopic biliary drainage at an initial ERCP. ERCP: Endoscopic retrograde cholangiopancreatography; NS: Not significant.

Table 5 Endoscopic retrograde cholangiopancreatography-related complications n (%)

	Age ≥ 80 yr	Age < 80 yr	P value
	(n = 102)	(n = 105)
Total	7 (6.9)	7 (6.7)	NS
Bleeding after EST	3 (2.9)	2 (1.9)	NS
Post-ERCP pancreatitis	1 (1.0)	4 (3.8)	< 0.05
Aggravation of cholangitis	2 (2.0)	1 (1.0)	NS
Aspiration pneumonia	1 (1.0)	1 (1.0)	NS
Mortality	0	0	NA

ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy; NS: Not significant; NA: Not available.

Table 6 Cardiorespiratory suppression during endoscopic retrograde cholangiopancreatography under moderate sedation n (%)

	Age≥80 yr	Age < 80 yr	P value
	(n = 102)	(n = 105)
Total	9 (8.8)	8 (7.6)	NS
Hypoxemia	2 (2.0)	2 (1.9)	NS
Bradycardia	4 (3.9)	4 (3.8)	NS
Hypotension	5 (4.9)	4 (3.8)	NS

Hypoxemia: Peripheral oxygen saturation (SpO2) below 90%; Bradycardia: Heart rate less than 45 beats per minutes; Hypotension: Systolic blood pressure below 80 mmHg; ERCP: Endoscopic retrograde cholangiopancreatography; NS: Not significant.