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  • Title: Endoscopic papillary balloon dilation for the management of bile duct stones in patients 85 years of age and older.
    Author: Ito Y, Tsujino T, Togawa O, Yamamoto N, Isayama H, Nakata R, Kawabe T, Omata M.
    Journal: Gastrointest Endosc; 2008 Sep; 68(3):477-82. PubMed ID: 18760175.
    Abstract:
    BACKGROUND: Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy for the treatment of bile duct stones. However, little information is available in the elderly. OBJECTIVE: Our purpose was to evaluate the safety and efficacy of EPBD for bile duct stones in patients of 85 years of age and older. DESIGN: Retrospective study from a single center. SETTING: Tertiary care facility with experience in bile duct stone removal with EPBD. PATIENTS: A total of 406 patients (74 patients >/=85 years old, group A; 332 patients <85 years old, group B) with bile duct stones underwent EPBD. MAIN OUTCOME MEASUREMENTS: Efficacy and safety of EPBD between the 2 groups. Baseline patient characteristics were also evaluated. RESULTS: The mean American Society of Anesthesiologists score in group A was significantly higher compared with that in group B (2.4 [0.5] vs 1.9 [0.7], P < .0001). Patients received anticoagulants more frequently and had larger and more numerous stones in group A than in group B with significant differences. Overall, bile duct clearance rates were similar in the 2 groups (91% vs 95%), but the mean number of sessions required for complete stone removal was significantly higher in group A (1.6 vs 1.4, P = .0081). The incidence of overall early complications after EPBD was lower in group A than in group B (2.7% vs 8.4%) but was not statistically different. None of the patients in group A had post-EPBD pancreatitis, whereas pancreatitis occurred in 5.7% in group B (P = .036). Bleeding was not observed after EPBD in 406 patients, including 7 patients in group A who received anticoagulation therapy at the time of EPBD. There was no significant difference in the cumulative stone nonrecurrence rate between group A and group B (log-rank test, P = .6225). CONCLUSIONS: EPBD is a safe and effective technique for the treatment of bile duct stones even in high-risk elderly patients without an increased risk of pancreatitis and bleeding. Because the evaluation of outcomes might be biased by our study design (an open study), further studies are needed.
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