Mustafa KAPLAN, Bülent ÖDEMİŞ, Selçuk DİŞİBEYAZ, Volkan GÖKBULUT, Orhan COŞKUN, Adem AKSOY

85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografi’nin etkinliği ve güvenilirliği

Giriş ve Amaç: Bu çalışmada 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografinin endikasyonları, bulguları, başarısı ve komplikasyonları araştırıldı. Gereç ve Yöntem: Bu çalışmada 2015-2019 yılları arasında endoskopik retrograd kolanjiyopankreatografi yapılan hastaların kayıtları incelenmiş ve çalışma 85 yaş üzeri 289 hasta ile yapılmıştır. Bulgular: Çalışma 169 kadın (%58) ve 120 erkek (%42) olmak üzere toplam 289 hasta ile yapılmıştır. Hastaların ortalama yaşı 88 idi (85-108). Endoskopik retrograd kolanjiyopankreatografinin en sık endikasyonları izole karaciğer enzim yüksekliği (%39), kolanjit (%32) ve karaciğer enzim yüksekliği olmaksızın karın ağrısıydı (%21). Hastaların %66’sına yatırılarak, %87.2’sine sadece tek seans endoskopik retrograd kolanjiyopankreatografi yapılmıştı. Hastaların %28’inde divertikül mevcuttu ve %25’i sfinkterotomiliydi. Hastaların %99’u ilk seansta, tamamı ise ikinci seansta kanülize edildi. 241 hastada selektif (%83), 48 hastada precut (%16) yöntemi kullanıldı. En sık endoskopik retrograd kolanjiyopankreatografi bulguları koledok taşı (%71) ve malign biliyer darlıktı (%12). En sık görülen maligniteler ise pankreas kanseri (%38) ve kolanjiyokanserdi (%32). Taş çıkanlarda teknik başarı %99, malign hastalarda ise %100 idi. Çalışmamızda en sık görülen komplikasyonlar post-endoskopik retrograd kolanjiyopankreatografi pankreatiti (%5.8) ve kanama (%2) idi. Bir hastada tip 1 perforasyon gelişti ve hasta exitus oldu. Üç yıllık takipte mortalite oranı %26 iken 30 günlük mortalite oranı %8 olarak bulunmuştur. Sonuç: Eşlik eden kronik hastalıklara rağmen, 85 yaş ve üstü hastalarda endoskopik retrograd kolanjiyopankreatografi güvenli ve etkili bir tedavi yöntemidir.

Anahtar Kelimeler:

Geriatri, safra kanalı taşları, endoskopik retrograd kolanjiyopankreatografi

Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients aged ≥85 years

Background and Aims: We investigated the indications, findings, and success and complication rates using endoscopic retrograde cholangiopancreatography in patients aged ≥85 years. Materials and Methods: The study included 289 patients aged ≥85 years. The records of patients who had undergone endoscopic retrograde cholangiopancreatography between 2015 and 2019 were examined. Results: The study population included 169 females (58%) and 120 males (42%) with a mean age of 88 years (range, 85-108 years). The most common indications for endoscopic retrograde cholangiopancreatography were isolated liver enzyme level elevation (39%), cholangitis (32%), and abdominal pain without elevated liver enzyme levels (21%). Of the total, 66% patients were hospitalized and 87.2% patients required only 1 endoscopic retrograde cholangiopancreatography session. Diverticulum was present in 28% patients, and 25% had prior sphincterotomy. Cannulation in the first session was performed for 99% patients and in the second session for the remaining. Of the total, selective method was used in 241 patients (83%) and precut method in 48 patients (16%). The most common endoscopic retrograde cholangiopancreatography findings included choledochal stone (71%) and malignant biliary stenosis (12%). The most common malignancies included pancreatic cancer (38%) and cholangiocarcinoma (32%). A 99% technical success was achieved in patients with stone, which was 100% in patients with malignancy. The most common complications included post- endoscopic retrograde cholangiopancreatography pancreatitis (5.8%) and bleeding (2%). One patient experienced type 1 perforation and died. The 30-day mortality rate was 8%, which increased to 26% at the 3-year follow-up. Conclusion: Despite concomitant chronic diseases, endoscopic retrograde cholangiopancreatography is a safe and effective treatment for patients aged ≥85 years.

Keywords:

Geriatrics, bile duct stones, endoscopic retrograde cholangiopancreatography,

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