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Treatment of Acute Cholangitis Due to Choledocholithiasis in Elderly and Younger Patients

Treatment of Acute Cholangitis Due to Choledocholithiasis in Elderly and Younger Patients Abstract Objective: To evaluate management strategies for acute cholangitis in elderly patients (age, ≥80 years). Design: Nonrandomized control trial. Setting: A university hospital. Patients: Patients (n= 191) who underwent urgent biliary drainage for acute cholangitis due to choledocholithiasis. Thirty-seven patients were elderly, and 154 were younger (age, <80 years). Interventions: Surgical (8 elderly and 48 younger patients), percutaneous transhepatic (11 elderly and 47 younger patients), or endoscopic drainage (18 elderly and 59 younger patients). Main Outcome Measures: Clinical features of acute cholangitis and outcomes of biliary drainage. Results: The elderly patients had higher incidences of septic shock or mental confusion (acute severe cholangitis) (43.2%) and concomitant diseases (81.1%) than the younger patients (25.3% and 42.9%, respectively). The elderly patients had significantly greater morbidity (37.8%) and mortality (10.8%), compared with the younger patients (16.9% and 3.2%, respectively). Mortality was 18.8% in elderly patients with severe cholangitis and 4.8% in those with nonsevere cholangitis. In the elderly patients, endoscopic drainage yielded lower morbidity (16.7%) and mortality (5.6%) than surgical (87.5% and 25.0%, respectively) and percutaneous drainage (36.4% and 9.1%, respectively). No complications occurred after endoscopic nasobiliary drainage without sphincterotomy. Conclusions: Elderly patients with acute cholangitis have high incidence of severe disease and concomitant medical problems. They should undergo endoscopic biliary drainage, especially nasobiliary drainage without sphincterotomy, because of its safety and effectiveness.Arch Surg. 1997;132:1129-1133 References 1. Leese T, Neoptolemos JP, Baker AR, Carr-Locke DL. Management of acute cholangitis and the impact of endoscopic sphincterotomy . Br J Surg . 1986;73:988-992.Crossref 2. Gigot JF, Leese T, Dereme T, et al. Acute cholangitis: multivariate analysis of risk factors . Ann Surg . 1989;209:435-438.Crossref 3. Gliedman M, Wilk P. The present status of biliary tract surgery . Surg Annu . 1985; 17:76-100. 4. Csendes A, Diaz JC, Burdiles P, et al. Risk factors and classification of acute suppurative cholangitis . Br J Surg . 1992;79:655-658.Crossref 5. Leung JWC, Chung SCS, Sung JJY, et al. Urgent endoscopic drainage for acute suppurative cholangitis . Lancet . 1989;1:1307-1309.Crossref 6. Lai ECS, Tam PC, Paterson IA, et al. Emergency surgery for severe acute cholangitis: the high-risk patients . Ann Surg . 1990;211:55-59.Crossref 7. Sugiyama M, Atomi Y, Kuroda A, Muto T. Treatment of choledocholithiasis in patients with liver cirrhosis: surgical treatment or endoscopic sphincterotomy? Ann Surg . 1993;218:68-73.Crossref 8. Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic biliary drainage for severe acute cholangitis . N Engl J Med . 1992;326:1582-1586.Crossref 9. Ikeda S, Tanaka M, Yoshimoto H, et al. Endoscopic biliary drainage for acute obstructive cholangitis: analysis of 100 consecutive patients . Dig Endosc . 1990;2: 214-217.Crossref 10. Gogel HK, Runyon BA, Volpicelli NA, Palmer RC. Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy . Gastrointest Endosc . 1987;33:210-213.Crossref 11. Pessa ME, Hawkins IF, Vogel SB. The treatment of acute cholangitis: percutaneous transhepatic biliary drainage before definitive therapy . Ann Surg . 1987; 205:389-392.Crossref 12. Lois JF, Gomes AS, Grace PA, et al. Risks of percutaneous transhepatic drainage in patients with cholangitis . AJR Am J Roentgenol . 1987;148:367-371.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Treatment of Acute Cholangitis Due to Choledocholithiasis in Elderly and Younger Patients

Sugiyama, Masanori; Atomi, Yutaka
Archives of Surgery , Volume 132 (10) – Oct 1, 1997
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References (14)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430340083015
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To evaluate management strategies for acute cholangitis in elderly patients (age, ≥80 years). Design: Nonrandomized control trial. Setting: A university hospital. Patients: Patients (n= 191) who underwent urgent biliary drainage for acute cholangitis due to choledocholithiasis. Thirty-seven patients were elderly, and 154 were younger (age, <80 years). Interventions: Surgical (8 elderly and 48 younger patients), percutaneous transhepatic (11 elderly and 47 younger patients), or endoscopic drainage (18 elderly and 59 younger patients). Main Outcome Measures: Clinical features of acute cholangitis and outcomes of biliary drainage. Results: The elderly patients had higher incidences of septic shock or mental confusion (acute severe cholangitis) (43.2%) and concomitant diseases (81.1%) than the younger patients (25.3% and 42.9%, respectively). The elderly patients had significantly greater morbidity (37.8%) and mortality (10.8%), compared with the younger patients (16.9% and 3.2%, respectively). Mortality was 18.8% in elderly patients with severe cholangitis and 4.8% in those with nonsevere cholangitis. In the elderly patients, endoscopic drainage yielded lower morbidity (16.7%) and mortality (5.6%) than surgical (87.5% and 25.0%, respectively) and percutaneous drainage (36.4% and 9.1%, respectively). No complications occurred after endoscopic nasobiliary drainage without sphincterotomy. Conclusions: Elderly patients with acute cholangitis have high incidence of severe disease and concomitant medical problems. They should undergo endoscopic biliary drainage, especially nasobiliary drainage without sphincterotomy, because of its safety and effectiveness.Arch Surg. 1997;132:1129-1133 References 1. Leese T, Neoptolemos JP, Baker AR, Carr-Locke DL. Management of acute cholangitis and the impact of endoscopic sphincterotomy . Br J Surg . 1986;73:988-992.Crossref 2. Gigot JF, Leese T, Dereme T, et al. Acute cholangitis: multivariate analysis of risk factors . Ann Surg . 1989;209:435-438.Crossref 3. Gliedman M, Wilk P. The present status of biliary tract surgery . Surg Annu . 1985; 17:76-100. 4. Csendes A, Diaz JC, Burdiles P, et al. Risk factors and classification of acute suppurative cholangitis . Br J Surg . 1992;79:655-658.Crossref 5. Leung JWC, Chung SCS, Sung JJY, et al. Urgent endoscopic drainage for acute suppurative cholangitis . Lancet . 1989;1:1307-1309.Crossref 6. Lai ECS, Tam PC, Paterson IA, et al. Emergency surgery for severe acute cholangitis: the high-risk patients . Ann Surg . 1990;211:55-59.Crossref 7. Sugiyama M, Atomi Y, Kuroda A, Muto T. Treatment of choledocholithiasis in patients with liver cirrhosis: surgical treatment or endoscopic sphincterotomy? Ann Surg . 1993;218:68-73.Crossref 8. Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic biliary drainage for severe acute cholangitis . N Engl J Med . 1992;326:1582-1586.Crossref 9. Ikeda S, Tanaka M, Yoshimoto H, et al. Endoscopic biliary drainage for acute obstructive cholangitis: analysis of 100 consecutive patients . Dig Endosc . 1990;2: 214-217.Crossref 10. Gogel HK, Runyon BA, Volpicelli NA, Palmer RC. Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy . Gastrointest Endosc . 1987;33:210-213.Crossref 11. Pessa ME, Hawkins IF, Vogel SB. The treatment of acute cholangitis: percutaneous transhepatic biliary drainage before definitive therapy . Ann Surg . 1987; 205:389-392.Crossref 12. Lois JF, Gomes AS, Grace PA, et al. Risks of percutaneous transhepatic drainage in patients with cholangitis . AJR Am J Roentgenol . 1987;148:367-371.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Oct 1, 1997

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