Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

We investigated the safety and utility of endoscopic removal of common bile duct stones (CBDS) in the elderly. In all, 253 patients with CBDS who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2007 and December 2011 at Showa University Hospital were evaluated retorspectively. The median age of the patients was 75 years ; thus, we divided patients into two groups, those aged ≥ 75 years (Group A ; n ＝ 134) and those aged ＜75 years (Group B ; n ＝ 119). Patients in Group A had significantly higher rates of endoscopic sphincterotomy in palliative ERCP (24.8% vs. 10.7%; p ＝ 0.008) and palliative removal of CBDS (34.8% vs. 20.9%; p ＝ 0.015) than patients in Group B. However, the median dose of flunitrazepam was significantly lower for patients in Group A than Group B (1 vs. 1.4 mg, respectively ; p ＜ 0.001). The rate of use of pentazocine (18.5% vs. 54.7%; p ＜ 0.001) and scopolamine butylbromide (6.2% vs. 23.9%; p ＜ 0.01) was significantly lower in Group A patients, whereas the use of glucagon was significantly higher in this group (43.8 vs. 15.4%; p ＜ 0.001). There were no significant differences in the rate of successful endoscopic removal of CBDS, treatment time, complications, and the recurrence of CBDS between the two groups. Endoscopic removal of CBDS in the elderly is a safe procedure with good outcomes if the appropriate treatment is selected.