Sa1308 ENDOSCOPIC TREATMENT OF SYMPTOMATIC COMMON BILE DUCT STONES IN THE ELDERLY

Abstract

Regardless of age, in Japan it is recommended that the complete removal of stones be achieved for the management of common bile duct (CBD) stones. However, in many elderly patients stones cannot be safely removed at the initial procedure because of their age and the time required to deal with many and/or large stones. In those patients endoscopic biliary stenting (EBS) is recommended as an alternative. To examine the outcome of endoscopic treatment for elderly patients with symptomatic CBD stones. From January 2016 to May 2017, we performed endoscopic retrograde cholangiopancreatography for 59 elderly patients with cholangitis due to CBD stones. Two groups were evaluated: complete clearance of CBD stones (stone clearance group) and a stenting group where drainage with a 7 Fr. double-pigtail side hole plastic stent was performed. Because of advanced age, there was no plan for regular stent changing. We compared patient profiles, procedure time, adverse events, recurrence rates of cholangitis and the time until recurrence between the two groups. The stone clearance group had 45 patients (26 men) vs. 14 in the stenting group (2 men) (P <0.001). Stenting group patients were significantly older (median age 88, range 78-96) than the stone clearance group (median age 75, range 29-96), P<0.001. The median procedure time was less with stenting than stone removal: 14 min (range 9-26) vs. 27 min (range 6-53), P <0.001. No adverse events occurred in either group. Recurrence of cholangitis was lowest in the stone clearance group [18% (8/45) vs. the stenting group, 43% (6/14), P=0.054]. However, the median time to recurrence of cholangitis was similar between those undergoing stone clearance and stenting [13.8 months (range 1-31) vs. 11 months (range 2-29), P=0.69] (Fig. 1). Although biliary stenting is an effective alternative for acute management of symptomatic choledocholithiasis in ill elderly patients, almost half suffered recurrence of cholangitis. Long term placement of a single stent is not an optimal solution. Whether stone removal after cholangitis subsides or placement of multiple stents would reduce recurrent cholangitis remains to be studied.