G D De Palma1, C Catanzano. 1. Department of Surgery, University of Naples Federico II, School of Medicine, Italy.
Abstract
BACKGROUND: The value of endoprostheses for long-term management of bile duct stones has not been formally established. We retrospectively compared the results of this method versus surgical approach in elderly patients (>70 years) with endoscopically irretrievable bile duct stones. METHODS: From January 1990 to September 1998, 68 patients over 70 years old underwent endoscopic biliary stenting (group A: 31 patients) or surgery (group B: 37 patients) for endoscopically irretrievable bile duct stones. The groups were similar with regard to gender, age, clinical presentation, ASA score, and number and size of the stones. RESULTS: Successful biliary drainage was achieved in 31 of 31 patients of group A and 37 of 37 patients of group B. Early complications occurred in 12.9% of group A versus 29.7% of group B (P <0.005) and early mortality was 0% in group A versus 2.7% of group B (P = NS). Over the long-term follow-up, late complications occurred in 35.5% of group A versus 8.1 % of group B (P <0.001). Three cases of biliary-related death occurred in group A versus 0 in group B (9.6% versus 0%: P <0.005). CONCLUSIONS: For immediate bile duct drainage endoprostheses proved a safe and effective alternative to surgery in elderly patients with endoscopically irretrievable bile duct stones. Because of the risk of subsequent complications, their use as a definitive treatment should be restricted to highly selected cases.
BACKGROUND: The value of endoprostheses for long-term management of bile duct stones has not been formally established. We retrospectively compared the results of this method versus surgical approach in elderly patients (>70 years) with endoscopically irretrievable bile duct stones. METHODS: From January 1990 to September 1998, 68 patients over 70 years old underwent endoscopic biliary stenting (group A: 31 patients) or surgery (group B: 37 patients) for endoscopically irretrievable bile duct stones. The groups were similar with regard to gender, age, clinical presentation, ASA score, and number and size of the stones. RESULTS: Successful biliary drainage was achieved in 31 of 31 patients of group A and 37 of 37 patients of group B. Early complications occurred in 12.9% of group A versus 29.7% of group B (P <0.005) and early mortality was 0% in group A versus 2.7% of group B (P = NS). Over the long-term follow-up, late complications occurred in 35.5% of group A versus 8.1 % of group B (P <0.001). Three cases of biliary-related death occurred in group A versus 0 in group B (9.6% versus 0%: P <0.005). CONCLUSIONS: For immediate bile duct drainage endoprostheses proved a safe and effective alternative to surgery in elderly patients with endoscopically irretrievable bile duct stones. Because of the risk of subsequent complications, their use as a definitive treatment should be restricted to highly selected cases.
Authors: P Katsinelos; I Galanis; I Pilpilidis; G Paroutoglou; P Tsolkas; B Papaziogas; S Dimiropoulos; E Kamperis; D Katsiba; M Kalomenopoulou; A Papagiannis Journal: Surg Endosc Date: 2003-08-15 Impact factor: 4.584