Abstract: Objective:To explore the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP) for elderly patients with periampullary diverticula accompanied with choledocholithiasis.
Methods:The retrospective crosssectional study was conducted. The clinical data of 297 elderly patients with age >70 years and periampullary diverticula accompanied with choledocholithiasis who were admitted to the Zhongshan Hospital affiliated to Fudan University between January 2013 and January 2016 were collected. All the patients received lithotomy by ERCP after completion of preoperative preparation, and then underwent symptomatic treatment. Observation indicators included: (1) treatment results: cannulation time, success rate of cannulation and success rate of stones removed; (2) surgical complications: hemorrhage, perforation and pancreatitis; (3) followup results. All patients were followed up by outpatient examination and telephone interview up to December 2016. Followup included postoperative delayed perforation, patients′ survival, further attack of acute cholangitis and reoperation for removing stones. Measurement data with normal distribution were represented as ±s, and measurement data with skewed distribution were described as M (range).
Results:(1) Treatment results: all the 297 patients underwent successful lithotomy by ERCP, with a cannulation time of (5±4)minutes and a success rate of cannulation of 100.00%(297/297). Of 297 patients, 292 had oneoff success of stones removed, with a oneoff success rate of 98.32%(292/297), and 5 received partial stones removed due to choledocholithiasis combined with acute cholangitis. (2) Surgical complications: 4 patients were complicated with immediate hemorrhage during intraoperative endoscopic sphincterotomy (EST). Bleeding of 1 patient was cauterized by biopsy forceps, and 3 patients had simplex JHYBAL compression hemostasis. Two patients with postoperative delayed hemorrhage had successful hemostasis by biopsy forceps with metal hemostatic clip under endoscope after emergency duodenoscopy. One patient with intraoperative perforation was cured by conservative treatment. Two patients with severe acute pancreatitis underwent continuous gastrointestinal decompression combined with maintenance therapy of somatostatin, and then received endoscopic ultrasoundguided puncture and drainage for pseudocyst around the pancreas, with a stable symptoms of pancreatitis after 4 weeks. (3) Followup results: all the 297 patients were followed up for 6-12 months, with a median time of 8 months. During followup, 292 patients had healthy survival, without recurrences of cholangitis and bile duct stone, and no delayed perforation and death were detected. Five patients underwent the second time lithotomy by ERCP after 2-3 months postoperatively.
Conclusion:Lithotomy by ERCP is safe and effective in the treatment of elderly patients with periampullary diverticula accompanied with choledocholithiasis.