Abstract
The strategy of first choice at this hospital for emergency treatment of gallstones in the extremely elderly, that is, cases 80 years old or older, is endoscopic nasobiliary drainage (ENBD) with EST for cholangitis, and percutaneous transhepatic gallbladder drainage (PTGBD) for cholecystitis. Bile duct stones are treated by endoscopic sphincterotomy (EST) and lithotomy. There are also instances in which asymptomatic gallstones in the gallbladder are allowed to remain after choledocholithotomy. We conducted an analysis of the results of therapeutic endoscopy for cholangitis in the extremely elderly, that is, patients 80 years old or older out of the 899 cases in which therapeutic endoscopy was performed over the last 20 years, 140 sessions of the procedure were performed in 135 emergency cases over the age of 80. There were 3 deaths all the 3 were serious cases already suffering from MOF, and were among the early cases when ENBD was placed without EST. There have been no deaths since 1992, when the treatment policy was changed to ENBD with EST, with the goal of providing definitive drainage, and in regard to complications, 1 case of post-EST bleeding and 5 cases of aspiration pneumonia were noted. Thus, therapeutic endoscopy for cholangitis has minimal complications and is a safe and useful procedure even for the elderly. Concomitant use of ENBD with EST is useful for obtaining definitive drainage, and EST with its small incision is useful in terms of preservation of the papillary function as well as safety.
