Urgent Endoscopic Retrograde Cholangiopancreatography Treatment Useful for Acute Cholangitis Caused by Bile Duct Stones in Patients Aged 90 Years and Older.

Background: Recently, the incidence of acute obstructive cholangitis caused by bile duct stones in patients aged 90 years and older (super-old) has been increasing, for which urgent endoscopic retrograde cholangiopancreatography (ERCP) treatment may be required. The aim of this study was to evaluate the efficacy and safety of urgent ERCP in super-old patients with acute cholangitis caused by bile duct stones.

Methods: A total 147 consecutive patients aged between 75 and 99 years who underwent urgent ERCP for acute cholangitis caused by bile duct stones were analyzed in a retrospective manner. They were divided into the old (age 75-89 years, control) and super-old (age 90-99 years) groups. Urgent ERCP efficacy and safety, including general status, ERCP-related findings and outcomes, cardiopulmonary monitoring during ERCP, and mortality, were compared between the groups.

Results: The physical status of the super-old group was worse than that of the old group. The success rates for biliary drainage and complete clearance of bile duct stones at the first attempt in the super-old group were lower as compared to the old group, while those after two attempts increased in the super-old group and were nearly the same as in the old group. No fatal cardiopulmonary complications during ERCP were observed in either group. Mortality rate within 2 months was higher in the super-old group, though recovered to the same level as in the old group after 2 months.

Conclusions: Efficacy and safety of urgent ERCP treatment in super-old patients were comparable to those seen in old patients, though the overall trend indicated greater difficulty. Urgent ERCP treatment can be useful for acute cholangitis caused by bile duct stones in super-old patients.