Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

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EUS-directed transgastric endoscopic retrograde cholangiopancreatography versus laparoscopic-assisted ERCP versus deep enteroscopy-assisted ERCP for patients with RYGB

Endoscopy International Open ◽

10.1055/a-1164-6282 ◽

2020 ◽

Vol 08 (07) ◽

pp. E877-E882 ◽

Cited By ~ 1

Author(s):

Gursimran S. Kochhar ◽

Nabeeha Mohy-ud-din ◽

Abhinav Grover ◽

Neil Carleton ◽

Abhijit Kulkarni ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Retrospective Chart Review ◽

Complication Rates ◽

Success Rates ◽

Technical Success ◽

Endoscopic Retrograde ◽

Technical Success Rate ◽

Edge Group ◽

History Of ◽

Laparoscopic Assisted

Abstract Background and study aims Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is a novel technique for managing pancreaticobiliary diseases in patients with a history of Roux-en-Y Gastric Bypass (RYGB). It has shown to have high technical success rates and fewer adverse events as compared to laparoscopic-assisted ERCP (LA-ERCP). We compared the technical success and clinical outcomes of EDGE vs. LA-ERCP vs. E-ERCP. Patients and methods A retrospective chart review was performed for 56 patients, of whom 18 underwent LA-ERCP, 12 underwent E-ERCP, and 26 had EDGE, and a comparison of technical success and complication rates was done. Results Baseline demographic characteristics of patients undergoing these procedures, including age and gender, were comparable. The technical success rate for patients in the EDGE group were 100 % (n = 26), compared with 94 % (n = 17) and 75 % (n = 9) in the LA-ERCP and E-ERCP groups (P = 0.02). In the EDGE group, 8 % of patients (n = 2) had bleeding, and 4 % of patients (n = 1) had lumen-apposing metal stent migration occur during the procedure. In the LA-ERCP group 6 % (n = 1) of patient had bleeding, 6 % (n = 1) post-ERCP pancreatitis and 6 % (n = 1) were diagnosed with an intra-abdominal infection post-procedure. Time to complete the EDGE procedure was significantly shorter at 79 ± 31 mins, compared with 158 ± 50 mins for LA-ERCP and 102 ± 43 mins for E-ERCP (P < 0.001). Conclusion EDGE is a novel procedure with short procedure times and an effective alternative to LA-ERCP and E-ERCP in management of pancreaticobiliary diseases in patients with a history of RYGB.

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Transcystic Removal of Common Bile Duct Stones in Surgically Altered Anatomy (Roux-en-Y Gastric Bypass)

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1739970 ◽

2021 ◽

Vol 12 (03) ◽

pp. 172-174

Author(s):

Surakshith K. Thyloor ◽

Vikas Singla ◽

Pradeep Chowbey

Keyword(s):

Gastric Bypass ◽

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Technical Success ◽

Endoscopic Retrograde ◽

Technical Success Rate ◽

Surgically Altered Anatomy ◽

Retrieval Device

AbstractEndoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy can be technically challenging. Various techniques have been described; however, the technical success rate depends on the type of reconstruction, length of the afferent limb, access to the papilla, availability of accessories, and adequate expertise. We describe successful transcystic removal of common bile duct stones in a patient with Roux-en-Y gastric bypass using cholangioscope and SpyGlass retrieval device at the time of cholecystectomy.

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Prospective Comparison of Moderate Conscious Sedation and Anesthesia Assistance for the Performance of Endoscopic Retrograde Cholangiopancreatography (ERCP)

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8892085 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ahmed Akhter ◽

Ravi Patel ◽

Eric Nelsen ◽

Mark E. Benson ◽

Deepak V. Gopal ◽

...

Keyword(s):

General Anesthesia ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Medical Center ◽

Cost Savings ◽

Success Rates ◽

Procedure Time ◽

Technical Success ◽

Endoscopic Retrograde ◽

Prospective Comparison

Objectives. Recent trends have favored the use of anesthesia personnel more frequently for advanced endoscopic procedures. We hypothesize a selective sedation approach based on patient and procedural factors using either moderate conscious sedation (MCS) or general anesthesia (GA) will result in similar outcomes and safety with significant cost savings. Methods. A 12-month prospective study of all adult endoscopic retrograde cholangiopancreatography (ERCPs) performed at a tertiary medical center was enrolled. Technical success, cannulation rates, procedural related complications, procedure time, and cost were compared between MCS and GA. Results. A total of 876 ERCPs were included in the study with 74% performed with MCS versus 26% with GA. The intended intervention was completed successfully in 95% of cases with MCS versus 96% cases with GA ( p = 0.59). Cannulation success rates with MCS were 97.5 versus 97.8% with GA ( p = 0.81). Overall, adverse event rates were similar in both groups (MCS: 6.6% vs. GA: 9.2%, p = 0.21). Mean procedure time was less for MCS versus GA, 18.3 and 26 minutes, respectively ( p < 0.0001). Selective use of MCS vs. universal sedation with GA resulted in estimated savings of $8,190 per case and $4,735,202 per annum. Conclusions. Preselection of ERCP sedation of moderate conscious sedation versus general anesthesia based upon patient risk factors and planned therapeutic intervention allows for the majority of ERCPs to be completed with MCS with similar rates of technical success and improvement in resource utilization and cost savings compared to performing ERCPs universally with anesthesia assistance.

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Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820980671 ◽

2020 ◽

Vol 13 ◽

pp. 175628482098067

Author(s):

Theodor Voiosu ◽

Andrei Voiosu ◽

Ivo Boškoski ◽

Marianna Arvanitakis ◽

Michiel Bronswijk ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Multivariable Analysis ◽

Secondary Outcome ◽

Control Group ◽

Minimal Risk ◽

Technical Failure ◽

Success Rates ◽

Technical Success ◽

Endoscopic Retrograde

Background: The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection. Methods: We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by the endoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case was matched in a 1:4 ratio with controls extracted from each center’s database in order to identify relevant changes in outcome measures compared with the pre-pandemic era. Results: Eighteen procedures performed in 16 COVID-19 patients [14 men, 65 years (9–82)] and 67 controls were included in the final analysis. Technical success was achieved in 14/18 COVID-19 cases, which was significantly lower as compared with the control group (14/18 versus 64/67, p = 0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse events was low in both groups (1/18 versus 10/67, p = 0.44). On multivariable analysis, COVID-19 status remained the only risk factor for technical failure of the procedure [odds ratio of 19.9 (95% confidence interval 1.4–269.0)]. Conclusions: The COVID-19 pandemic has affected the volume and practice of ERCP, resulting in lower technical success rates without significantly impacting patient safety. Prioritizing cases and following recommendations on safety measures can ensure good outcome with minimal risk in dedicated centers.

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SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery

British Journal of Surgery ◽

10.1093/bjs/znab361.134 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahab Hajibandeh ◽

Shahin Hajibandeh ◽

Moustafa Mansour ◽

Thomas Satyadas

Keyword(s):

Gastric Bypass ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Case Series ◽

Complication Rates ◽

Success Rates ◽

Technical Success ◽

Endoscopic Retrograde ◽

The Mean ◽

Laparoscopic Assisted ◽

Procedural Outcomes

Abstract Aims To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. Results A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4). Conclusions Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.

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Efficacy of endoscopic retrograde cholangiopancreato-graphy in elderly patients

Bangladesh Medical Journal ◽

10.3329/bmj.v45i1.28967 ◽

2016 ◽

Vol 45 (1) ◽

pp. 44-46

Author(s):

Chittaranjan Das ◽

Ashis Saha ◽

Faruk Hossain ◽

Md Mokhlesur Rahman ◽

Rakibul Hasan ◽

...

Keyword(s):

Observational Study ◽

Elderly Patients ◽

Biliary Tract ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Prospective Observational Study ◽

The Elderly ◽

Therapeutic Use ◽

Data Sheet ◽

Endoscopic Retrograde ◽

Therapeutic Ercp

The incidence of biliary tract pathologies increases as the population ages leading to an increase in the demand of therapeutic use of endoscopic retrograde cholangiopancreatography (ERCP). This study was carried out to assess the effectiveness of therapeutic ERCP in elderly patients. It was a prospective observational study. Patients aged 65 years or more referred for therapeutic ERCP from July 2007 to June 2008 were reviewed by a preformed data sheet which included all the relevant details of the procedure. It was collected at the time of ERCP & before discharge. Of 67 patients audited, successful therapeutic ERCP was performed in 91.04% cases. Our study showed that ERCP was effective in the elderly patients.Bangladesh Med J. 2016 Jan; 45 (1): 44-46

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Safety and Effectiveness of Endoscopic Band Ligation for Colonic Diverticular Bleeding in Elderly Patients

Digestion ◽

10.1159/000513310 ◽

2021 ◽

pp. 1-7

Author(s):

Takeshi Okamoto ◽

Kenji Nakamura ◽

Kazuki Yamamoto ◽

Takaaki Yoshimoto ◽

Ayaka Takasu ◽

...

Keyword(s):

Elderly Patients ◽

Multiple Logistic Regression Analysis ◽

The Elderly ◽

Endoscopic Hemostasis ◽

Technical Success ◽

Diverticular Bleeding ◽

Band Ligation ◽

Technical Success Rate ◽

Colonic Diverticular Bleeding ◽

Endoscopic Band Ligation

Introduction: Colonic diverticulosis increases with age, leading to a higher risk of colonic diverticular bleeding (CDB) in the elderly. As life expectancy continues to increase, the need for endoscopic hemostasis for CDB in the elderly can also be expected to increase. However, there have been no reports to date on the feasibility of endoscopic hemostasis for elderly CDB patients. Several recent studies have addressed the effectiveness of endoscopic band ligation (EBL) for CDB. In this study, we evaluate the safety and effectiveness of EBL in elderly CDB patients compared to younger CDB patients. Methods: We retrospectively analyzed the medical records of consecutive patients treated with EBL for the first time at a tertiary referral center between March 2011 and November 2017. Patients were grouped according to age into those at least 75 years old (the Elderly) and those <75 years old (the Nonelderly). Patient characteristics, technical success, and complications were compared between the two groups. Results: EBL was performed in 153 patients during the study period (49 Elderly patients and 104 Nonelderly patients). Elderly patients were less likely to be male (p < 0.001) and had lower hemoglobin levels on admission (p < 0.001). Bleeding on the right side of the splenic flexure was observed more frequently in the Nonelderly (p = 0.002). Charlson Comorbidity Index (CCI) and use of antithrombotic agents were significantly higher in the Elderly (p < 0.001 and p < 0.001, respectively). Active bleeding tended to be observed more frequently in the Elderly (p = 0.054), while the difference was not significant. There were no significant differences in the shock index, procedure time, or units of packed red blood cells transfused between the 2 groups. No significant differences in the technical success rate (97.1 vs. 98%, p = 0.76), early rebleeding rate (10.2 vs. 14.4%, p = 0.47), or other complications (2 vs. 1%, p = 0.58) were observed. Perforation and abscess formation were not observed in either group. Female gender, left-sidedness, higher CCI, and lower hemoglobin level were all significantly more frequently observed in the Elderly on multiple logistic regression analysis. Discussion/Conclusion: EBL may be similarly safe and effective for the treatment of CDB in the elderly as in the nonelderly.

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Acute pancreatitis in the older patient: Is a new risk score required?

Journal of the Intensive Care Society ◽

10.1177/1751143720937877 ◽

2020 ◽

pp. 175114372093787

Author(s):

Michael F Bath ◽

Robin Som ◽

Daniel Curley ◽

Rajab Kerwat

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Elderly Patients ◽

Endoscopic Retrograde Cholangiopancreatography ◽

The Elderly ◽

Surgical Patient ◽

Endoscopic Retrograde ◽

Co Morbidity ◽

Severity Scores ◽

One Year

Introduction The average age of the surgical patient in the UK is increasing. Frailty and cognitive impairment have been shown to be important risk factors in elderly patients with surgical pathology. Limited work has previously assessed the outcomes of acute pancreatitis in the elderly population and the usefulness of current severity scoring methods. We aimed to assess the mortality rates in this cohort and identify any factors that may influence patient outcome. Methods All patients ≥ 80 years admitted with acute pancreatitis between 1 January 2014 and 31 May 2018 were retrospectively identified. Disease severity scores were measured by a modified Ranson score, and patients' co-morbidities were quantified with the Charlson Comorbidity Index. Primary endpoint was whether the patient was alive at discharge; multilevel logistic regression was used to identify any independent risk factors for patient outcomes. Results Eighty-seven patients were included, with an average age of 86 years. The most common aetiology was gallstones. Nine patients died during admission, and ITU admission was the only predictor of mortality (p = 0.027). Twenty-three patients had died by one year. Endoscopic retrograde cholangiopancreatography was more common in patients with gallstone disease who were alive at one year (p = 0.029). Discussion Risk severity and co-morbidity scores are not predictive of outcomes in elderly patients with acute pancreatitis. The use of endoscopic retrograde cholangiopancreatography should be considered in elderly patients with acute gallstone pancreatitis where suitable. Further work is needed to identify improved mortality prediction tools in the elderly with acute pancreatitis and optimal management strategies.

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OPTIMAL TIMING OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN ELDERLY PATIENTS WITH ACUTE CHOLANGITIS

10.1055/s-0039-1681862 ◽

2019 ◽

Author(s):

B Miutescu ◽

I Ratiu ◽

A Popescu ◽

R Sirli ◽

M Danila ◽

...

Keyword(s):

Elderly Patients ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Acute Cholangitis ◽

Optimal Timing ◽

Endoscopic Retrograde

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Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

Scientific Reports ◽

10.1038/s41598-021-84024-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Akihiko Kida ◽

Yukihiro Shirota ◽

Taro Kawane ◽

Hitoshi Omura ◽

Tatsuo Kumai ◽

...

Keyword(s):

Adverse Events ◽

Anastomotic Stenosis ◽

Technical Success ◽

Long Term Outcomes ◽

Endoscopic Retrograde ◽

Technical Success Rate ◽

Registration Number ◽

Clinical Trial Register

AbstractThere is limited evidence supporting the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. We conducted a retrospective analysis of 10 benign sPJS patients. A forward-viewing endoscope was used in all sessions. Following items were evaluated: technical success, adverse events, and clinical outcome of ERPD. The technical success rate was 100% (10/10) in initial ERPD; 9 patients had a pancreatic stent (no-internal-flap: n = 4, internal-flap: n = 5). The median follow-up was 920 days. Four patients developed recurrence. Among them, 3 had a stent with no-internal-flap in initial ERPD, the stent migrated in 3 at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up interventions were performed. No recurrence was observed in 6 patients. None of the stents migrated (no-internal-flap: n = 1, internal-flap: n = 5) and no stents were replaced due to stent failure. Stenting with no-internal-flap was associated with recurrence (p = 0.042). Mild adverse events developed in 14.3% (2/14). In conclusions, ERPD was performed safely with high technical success. Recurrence was common after stenting with no-internal-flap. Long-term stenting did not result in stent failure.Clinical trial register and their clinical registration number: Nos. 58-115 and R2-9.

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