Value of ERCP on Diagnosis of Obstructive Jaundice in Elderly Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Xudong ¹ , WU Yaqun ¹ , LIU Zhisu ² , SUN Quan ² , ZHANG Lin ¹

1.Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China;;
2.Department of General Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, Hubei Province, China;

Corresponding author：

XU Xudong , Email: georgexxd@126.com

Keywords：

Endoscopic retrograde cholangiopancreatography; Elderly patients; Obstructive jaundice; Diagnosis; Application value

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ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (P gt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (P gt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), P lt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, P gt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.

Citation： XU Xudong ,WU Yaqun,LIU Zhisu,SUN Quan,ZHANG Lin. Value of ERCP on Diagnosis of Obstructive Jaundice in Elderly Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(1): 55-58. doi: Copy

1.	Hancock SM, Spier BJ, Pfau PR. Hemorrhagic emphysematous cholecystitis presenting as obstructive jaundice and hemobilia [J]. Gastrointest Endosc, 2008， 68(1): 151152.
2.	Papachristou GI, Smyrk TC, Baron TH. Endoscopic retrograde cholangiopancreatography tissue sampling: when and how? [J]. Clin Gastroenterol Hepatol, 2007， 5(7): 783790.
3.	Burdiukov MS, Nechipaǐ AM, Iurichev IN. Assessment of severity of obstructive jaundice of tumoral genesis for predicting of endoscopic retrograde cholangiopancreatography and endoscopic retrograde biliary decompression complications [J]. Eksp Klin Gastroenterol, 2010， (4): 7885.
4.	Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older [J]. Gastrointest Endosc, 2006， 63(3): 417423.
5.	Laasch HU. Obstructive jaundice after bilioenteric anastomosis: transhepatic and direct percutaneous enteral stent insertion for afferent loop occlusion [J]. Gut Liver, 2010， 4(Suppl.1): S89S95.
6.	Nakakura EK, Warren RS. Palliative care for patients with advanced pancreatic and biliary cancers [J]. Surg Oncol, 2007， 16(4): 293297.
7.	辛波，张林波，姜喜远，等. 恶性梗阻性黄疸介入治疗与手术引流比较 [J]. 中国普外基础与临床杂志, 2010， 17(3): 233236.
8.	Loew BJ, Howell DA, Raju R, et al. ERCP tissue sampling of cholangiocarcinoma presenting with biliary obstruction permits intraprocedural diagnosis and results in high positive yield [J]. Gastrointest Endosc, 2008， 67(5): AB229AB230.
9.	刘双, 刘军, 孙文生, 等. 硝酸甘油预防ERCP术后胰腺炎及高淀粉酶血症的临床应用研究 [J]. 中国普外基础与临床杂志, 2009， 16(8): 641644.
10.	Sasaki T, Kato D, Matsuoka N, et al. Limy bile syndrome complicated by obstructive jaundice [J]. Int Surg, 2010， 95(1): 4953.
11.	Matsubayashi H, Kakushima N, Onozawa Y, et al. Endoscopic biliary drainage using guidewire cannulation in a case with severe duodenal stenosis caused by duodenal undifferentiated carcinoma [J]. Case Rep Gastroenterol, 2010， 4(1): 2530.
12.	Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents postERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008， 67(2): 255261.
13.	李汛, 朱晓亮, 周文策, 等. 经内镜胰管支架置入在预防ERCP术后胰腺炎高危患者中的临床应用 [J]. 中国普外基础与临床杂志, 2010， 17(10): 10061009.
14.	Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla [J]. Clin Gastroenterol Hepatol, 2007， 5(9): 11131118.
15.	Ozdil B, Cosar A, Kece C, et al. The diagnostic value of endoscopic balloon catheter usage for detecting earlystage primary sclerosing cholangitis in endoscopic retrograde cholangiopancreatography: a case report [J]. Case Rep Gastroenterol, 2010， 4(1): 15.
16.	Nuwayhid NS, Ballard ET, Cotton R. Esophageal papillomatosis: case report [J]. Ann Otol Rhinol Laryngol, 1977， 86(5 Pt 1): 623625.
17.	Keil R, Snajdauf J, Rygl M, et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates-a retrospective study on a large series [J]. Endoscopy, 2010， 42(2): 121126.
18.	Papamichail M, Nikolaidis N, Anastasiou E, et al. Massive subcutaneus emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy [J]. Case Rep Gastroenterol, 2010， 4(3): 399403.
19.	GüitrónCantú A, AdalidMartínez R, GutiérrezBermúdez J, et al. Endoscopic retrograde cholagiopancreatography in the elderly: A prospective and comparative study in Northern Mexico [J]. Rev Gastroenterol Mex, 2010， 75(3): 267272.
20.	Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures [J]. J Am Coll Surg, 2008， 206(5): 918923.
21.	李汛, 朱晓亮, 沈亦萱, 等. 镇静、镇痛麻醉在治疗性ERCP中的安全性评估及应用 [J]. 中国普外基础与临床杂志, 2009， 16(8): 645648.
22.	Lundstrm P, Sandblom G, Osterberg J, et al. Effectiveness of prophylactic antibiotics in a populationbased cohort of patients undergoing planned cholecystectomy [J]. J Gastrointest Surg, 2010， 14(2): 329334.
23.	Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of postERCP pancreatitis [J]. Endoscopy, 2010， 42(6): 503515.
24.	李海洋, 孙诚谊, 潘耀振, 等. 不同途径胆道支架置入治疗恶性梗阻性黄疸42例回顾分析 [J]. 中国普外基础与临床杂, 2009， 16(4): 300303.
25.	金安琴, 黄晓俊, 王伟, 等. 早期内镜治疗急性胆源性胰腺炎46例临床研究 [J]. 中国普外基础与临床杂志, 2010， 17(10): 10011005.
26.	Bisceglia M, Simeone A, Forlano R, et al. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography [J]. Adv Anat Pathol, 2009， 16(4): 255262.

1. Hancock SM, Spier BJ, Pfau PR. Hemorrhagic emphysematous cholecystitis presenting as obstructive jaundice and hemobilia [J]. Gastrointest Endosc, 2008， 68(1): 151152.
2. Papachristou GI, Smyrk TC, Baron TH. Endoscopic retrograde cholangiopancreatography tissue sampling: when and how? [J]. Clin Gastroenterol Hepatol, 2007， 5(7): 783790.
3. Burdiukov MS, Nechipaǐ AM, Iurichev IN. Assessment of severity of obstructive jaundice of tumoral genesis for predicting of endoscopic retrograde cholangiopancreatography and endoscopic retrograde biliary decompression complications [J]. Eksp Klin Gastroenterol, 2010， (4): 7885.
4. Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older [J]. Gastrointest Endosc, 2006， 63(3): 417423.
5. Laasch HU. Obstructive jaundice after bilioenteric anastomosis: transhepatic and direct percutaneous enteral stent insertion for afferent loop occlusion [J]. Gut Liver, 2010， 4(Suppl.1): S89S95.
6. Nakakura EK, Warren RS. Palliative care for patients with advanced pancreatic and biliary cancers [J]. Surg Oncol, 2007， 16(4): 293297.
7. 辛波，张林波，姜喜远，等. 恶性梗阻性黄疸介入治疗与手术引流比较 [J]. 中国普外基础与临床杂志, 2010， 17(3): 233236.
8. Loew BJ, Howell DA, Raju R, et al. ERCP tissue sampling of cholangiocarcinoma presenting with biliary obstruction permits intraprocedural diagnosis and results in high positive yield [J]. Gastrointest Endosc, 2008， 67(5): AB229AB230.
9. 刘双, 刘军, 孙文生, 等. 硝酸甘油预防ERCP术后胰腺炎及高淀粉酶血症的临床应用研究 [J]. 中国普外基础与临床杂志, 2009， 16(8): 641644.
10. Sasaki T, Kato D, Matsuoka N, et al. Limy bile syndrome complicated by obstructive jaundice [J]. Int Surg, 2010， 95(1): 4953.
11. Matsubayashi H, Kakushima N, Onozawa Y, et al. Endoscopic biliary drainage using guidewire cannulation in a case with severe duodenal stenosis caused by duodenal undifferentiated carcinoma [J]. Case Rep Gastroenterol, 2010， 4(1): 2530.
12. Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents postERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008， 67(2): 255261.
13. 李汛, 朱晓亮, 周文策, 等. 经内镜胰管支架置入在预防ERCP术后胰腺炎高危患者中的临床应用 [J]. 中国普外基础与临床杂志, 2010， 17(10): 10061009.
14. Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla [J]. Clin Gastroenterol Hepatol, 2007， 5(9): 11131118.
15. Ozdil B, Cosar A, Kece C, et al. The diagnostic value of endoscopic balloon catheter usage for detecting earlystage primary sclerosing cholangitis in endoscopic retrograde cholangiopancreatography: a case report [J]. Case Rep Gastroenterol, 2010， 4(1): 15.
16. Nuwayhid NS, Ballard ET, Cotton R. Esophageal papillomatosis: case report [J]. Ann Otol Rhinol Laryngol, 1977， 86(5 Pt 1): 623625.
17. Keil R, Snajdauf J, Rygl M, et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates-a retrospective study on a large series [J]. Endoscopy, 2010， 42(2): 121126.
18. Papamichail M, Nikolaidis N, Anastasiou E, et al. Massive subcutaneus emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy [J]. Case Rep Gastroenterol, 2010， 4(3): 399403.
19. GüitrónCantú A, AdalidMartínez R, GutiérrezBermúdez J, et al. Endoscopic retrograde cholagiopancreatography in the elderly: A prospective and comparative study in Northern Mexico [J]. Rev Gastroenterol Mex, 2010， 75(3): 267272.
20. Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures [J]. J Am Coll Surg, 2008， 206(5): 918923.
21. 李汛, 朱晓亮, 沈亦萱, 等. 镇静、镇痛麻醉在治疗性ERCP中的安全性评估及应用 [J]. 中国普外基础与临床杂志, 2009， 16(8): 645648.
22. Lundstrm P, Sandblom G, Osterberg J, et al. Effectiveness of prophylactic antibiotics in a populationbased cohort of patients undergoing planned cholecystectomy [J]. J Gastrointest Surg, 2010， 14(2): 329334.
23. Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of postERCP pancreatitis [J]. Endoscopy, 2010， 42(6): 503515.
24. 李海洋, 孙诚谊, 潘耀振, 等. 不同途径胆道支架置入治疗恶性梗阻性黄疸42例回顾分析 [J]. 中国普外基础与临床杂, 2009， 16(4): 300303.
25. 金安琴, 黄晓俊, 王伟, 等. 早期内镜治疗急性胆源性胰腺炎46例临床研究 [J]. 中国普外基础与临床杂志, 2010， 17(10): 10011005.
26. Bisceglia M, Simeone A, Forlano R, et al. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography [J]. Adv Anat Pathol, 2009， 16(4): 255262.

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Value of ERCP on Diagnosis of Obstructive Jaundice in Elderly Patients

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