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Efficacy and Safety of Endoscopic Papillary Large Balloon Dilation for Large Bile Duct Stones in Elderly Patients

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Abstract

Background

Minimally invasive interventions for choledocholithiasis are preferable in elderly patients because they tend to have multiple underlying disorders or a decreased activity of daily living. Endoscopic sphincterotomy and endoscopic papillary balloon dilation have been recognized as first-line treatments for choledocholithiasis excluding difficult cases such as large stones or multiple stones. Recently, the safety and efficacy of endoscopic papillary large balloon dilation (EPLBD) for difficult choledocholithiasis cases have been reported, although scarcely in elderly patients.

Aims

To investigate whether EPLBD can be safety and effectively performed in patients aged 75 years or older.

Methods

The medical records of 165 patients who underwent EPLBD from November 2006 to August 2013 were analyzed retrospectively. The patients were divided into 2 groups: Group A (≥75 years); Group B (<75 years).

Results

Some underlying diseases were significantly more common in Group A than in Group B (P < 0.05). However, there was no significant difference in the success rates in the first session (96.2 vs 95.0 %, P = 0.970) and in the final success rates (100 % in both groups) between Group A and Group B. The adverse event rates (2.9 vs 5.0 %, P = 0.783) and recurrence rates of choledocholithiasis (6.7 vs 10.0 %, P = 0.444) were not significantly different. Regarding patients with an altered anatomy, the EPLBD outcome was not significantly different.

Conclusion

EPLBD can be safely performed for elderly patients similarly to younger patients.

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Abbreviations

AEs:

Adverse events

ASA:

American Society of Anesthesiologists

B-I:

Billroth-I gastrectomy

B-II:

Billroth-II gastrectomy

CBD:

Common bile duct

EPBD:

Endoscopic papillary balloon dilation

EPLBD:

Endoscopic papillary large balloon dilation

ERCP:

Endoscopic retrograde cholangiopancreatography

ES:

Endoscopic sphincterotomy

ML:

Mechanical lithotripsy

R-Y:

Roux-en-Y gastrectomy

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Acknowledgments

We are indebted to Dr. Edward Barroga, Associate Professor and Senior Medical Editor of the Department of International Medical Communications of Tokyo Medical University, for the editorial review of the English manuscript.

Conflict of interest

Fumihide Itokawa and Takao Itoi give remunerated lectures for Olympus Medical Systems and Boston Scientific Japan. The other authors disclose no financial relationship relevant to this publication.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Ryosuke Tonozuka, Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Reina Tanaka, Mitsuyoshi Honjyo, Shuntaro Mukai, Mitsuru Fujita & Fuminori Moriyasu

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  1. Ryosuke Tonozuka
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  2. Takao Itoi
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Correspondence to Ryosuke Tonozuka.

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Tonozuka, R., Itoi, T., Sofuni, A. et al. Efficacy and Safety of Endoscopic Papillary Large Balloon Dilation for Large Bile Duct Stones in Elderly Patients. Dig Dis Sci 59, 2299–2307 (2014). https://doi.org/10.1007/s10620-014-3156-9

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  • DOI: https://doi.org/10.1007/s10620-014-3156-9

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