Endoscopic papillary balloon dilation for the management of bile duct stones in patients 85 years of age and older

BackgroundEndoscopic 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.ObjectiveOur purpose was to evaluate the safety and efficacy of EPBD for bile duct stones in patients of 85 years of age and older.DesignRetrospective study from a single center.SettingTertiary care facility with experience in bile duct stone removal with EPBD.PatientsA 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 MeasurementsEfficacy and safety of EPBD between the 2 groups. Baseline patient characteristics were also evaluated.ResultsThe 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).ConclusionsEPBD 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.