1Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
2Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
3Department of Health Services Research, Maimonides Medical Center, Brooklyn, NY, USA
4Department of Pediatrics, Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
5Department of Clinical Medicine, Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
6Division of Gastroenterology, Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
Copyright © 2018 Korean Society of Gastrointestinal Endoscopy
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Overall (n=1,389) | Age ≥90 (n=74) | Age <90 (n=1,315) | p-value | |
---|---|---|---|---|
Age, median (IQR) | 67.0 (52, 80) | 92 (91, 93) | 65 (50, 78) | |
Charlson score, median (IQR) | 1.0 (0.0, 2.0) | 1.0 (0.0, 2.0) | 0.0 (0.0, 2.0) | 0.09a) |
Charlson score ≥2, % (n) | 28.0% (389) | 29.7% (22) | 27.9% (367) | 0.73b) |
Procedure time in minutes median (IQR)c) | 33:00 (22:06, 50:27) | 33:00 (22:00, 50:27) | 33:00 (24:00, 50:48) | 0.76 a) |
Male, % (n) | 40.6% (564) | 27.0% (20) | 41.4% (544) | 0.02b) |
Emergency, % (n) | 15.4% (214) | 9.5% (7) | 15.7% (207) | 0.15b) |
Success rate, % (n) | 89.4% (1242) | 89.2% (66) | 89.4% (1176) | 0.95b) |
Periampullary diverticulum, % (n) | 11.5% (160) | 28.4% (21) | 10.6% (139) | <0.001b) |
Sphincterotomy, % (n) | 58.5% (813) | 68.9% (51) | 57.9% (762) | 0.06b) |
Rectal indomethacin, % (n) | 27.3% (379) | 28.4% (21) | 27.2% (358) | 0.83b) |
Stent placement, % (n) | 73.5% (1020) | 74.3% (55) | 73.4% (965) | 0.87b) |
Ethnicitye) | ||||
Caucasian (not Jewish or Hispanic) | 34.8% (484) | 36.5% (27) | 34.8% (457) | |
Jewish | 27.6% (383) | 51.4% (38) | 26.2% (345) | |
African American | 5.3% (73) | 1.4% (1) | 5.5% (72) | |
Asian | 19.8% (275) | 10.8% (8) | 20.3% (267) | |
South Asian | 1.4% (20) | - | 1.5% (20) | |
Hispanic | 3.3% (46) | - | 3.5% (46) | |
Native American | 0.8% (11) | - | 0.8% (11) | |
Middle Eastern | 4.1% (57) | - | 4.3% (57) | |
Other/No response | 2.8% (40) | - | 3.0% (40) | |
Comorbidities | ||||
Coronary artery disease | 6.7% (93) | 6.8% (5) | 6.7% (88) | 1d) |
Congestive heart failure | 5.8% (81) | 18.9% (14) | 5.1% (67) | <0.001d) |
Chronic obstructive pulmonary disease | 3.7% (51) | 8.1% (6) | 3.4% (45) | 0.05d) |
Chronic kidney disease | 3.0% (41) | 8.1% (6) | 2.7% (35) | 0.019d) |
Cerebrovascular accident | 3.2% (45) | 8.1% (6) | 3.0% (39) | 0.029d) |
Diabetes mellitus | 25% (347) | 20.3% (15) | 25.2% (332) | 0.336b) |
Hypertension | 50.6% (703) | 73.0% (54) | 49.4% (649) | <0.001b) |
Peripheral vascular disease | 1.2% (17) | 4.1% (3) | 1.1% (14) | 0.058d) |
Dementia | 2.7% (37) | 16.2% (12) | 1.9% (25) | <0.001d) |
Peptic ulcer disease | 4.2% (58) | 5.4% (4) | 4.1% (54) | 0.546d) |
Indications | ||||
Biliary stones | 50.9% (707) | 60.8% (45) | 50.3% (662) | 0.004b) |
Cholangitis | 17.0% (236) | 24.3% (18) | 16.6% (218) | 0.004b) |
Abnormal imaging/mass | 32.1% (446) | 14.9% (11) | 33.1% (435) | 0.004b) |
Outcomes | ||||
In-patient mortality, % (n) | 2.2% (30) | 12.2% (9) | 1.6% (21) | <0.001b) |
Overall adverse event rate | 7.0% (97) | 4.1% (3) | 7.1% (94) | 0.31b) |
Individual adverse eventse) | ||||
Minor adverse event rate | 5.0% (69) | 4.1% (3) | 5.0% (66) | |
Major adverse event rate | 2.0% (28) | - | 2.1% (28) | |
Minor bleeding | 1.2% (16) | 1.4% (1) | 1.1% (15) | |
Fever | 1.7% (23) | 1.4% (1) | 1.7% (22) | |
Post-ERCP pancreatitis | 2.2% (30) | 1.4% (1) | 2.2% (29) | |
Mucosal injuries | 0.1% (1) | - | 0.1% (1) | |
Bleeding requiring transfusion | 1.2% (16) | - | 1.2% (16) | |
Bleeding requiring intervention | 0.6% (8) | - | 0.6% (8) | |
Perforation | 0.2% (3) | - | 0.2% (3) |
Adjusted odds ratio |
95% Confidence interval |
p-value | ||
---|---|---|---|---|
Lower | Upper | |||
Adverse events | ||||
Emergency procedure | 2.45 | 1.49 | 4.03 | <0.001 |
CCI ≥2 | 2.58 | 1.66 | 4.00 | <0.001 |
Age ≥90 | 0.52 | 0.16 | 1.70 | 0.28 |
Cholangitisa) | 0.49 | 0.27 | 0.91 | 0.02 |
Abnormal imaging/massa) | 0.35 | 0.20 | 0.62 | 0.35 |
Mortality | ||||
Emergency procedure | 0.72 | 0.23 | 2.23 | 0.57 |
CCI ≥2 | 2.44 | 1.15 | 5.20 | 0.02 |
Age ≥90 | 9.58 | 4.00 | 22.98 | <0.001 |
Cholangitisa) | 3.98 | 1.42 | 11.20 | 0.01 |
Abnormal imaging/massa) | 3.26 | 1.23 | 8.62 | 0.02 |
Year | Region |
No. of procedures/patients |
Success rate |
Adverse event rate |
Mortality rate |
|||||
---|---|---|---|---|---|---|---|---|---|---|
≥90 | <90 | ≥90 | <90 | ≥90 | <90 | ≥90 | <90 | |||
Sugiyama et al. [16] | 2000 | Japan | 22 | 381 | 100.0% | 98.4% | 4.5% | 6.8% | 0% | 0.3% |
Rodríguez-González et al. [15] | 2003 | Spain | 126 | - | 90.5% | - | 2.5% | - | 0.7% | - |
Mitchell et al. [14] | 2003 | Ireland | 23 | - | 91.3% | - | 13.0% | - | 13%a) | - |
Hui et al. [12] c) | 2004 | Hong Kong | 64 | 165 | 98.4% | 92.7% | 4.7% | 7.3% | 7.8%b) | 4.2%b) |
Huguet et al. [11] | 2005 | Spain | 42 | - | 85.7% | - | 14.4% | - | 0% | - |
Katsinelos et al. [13] | 2006 | Greece | 63 | 350 | 98.4% | 99.1% | 6.3% | 8.4% | 1.6% | 0.6% |
Cariani et al. [8] | 2006 | Italy | 40 | - | 82.0% | - | 0.0% | - | 0% | - |
Grönroos et al. [9] | 2010 | Finland | 41 | - | - | - | 7.0% | - | 10%d) | |
Hu et al. [10] | 2014 | China | 78 | 312 | 91.0% | 96.2% | 7.7% | 7.4% | - | - |
Yun et al. [17] | 2014 | Korea | 43 | 129 | 86.0% | 94.0% | 12.0% | 22.0% | 2% | 0% |
This study | US | 74 | 1,315 | 89.2% | 89.4% | 4.1% | 7.1% | 12.2%a) | 1.6%a) |
Overall (n=1,389) | Age ≥90 (n=74) | Age <90 (n=1,315) | p-value | |
---|---|---|---|---|
Age, median (IQR) | 67.0 (52, 80) | 92 (91, 93) | 65 (50, 78) | |
Charlson score, median (IQR) | 1.0 (0.0, 2.0) | 1.0 (0.0, 2.0) | 0.0 (0.0, 2.0) | 0.09 |
Charlson score ≥2, % (n) | 28.0% (389) | 29.7% (22) | 27.9% (367) | 0.73 |
Procedure time in minutes median (IQR) |
33:00 (22:06, 50:27) | 33:00 (22:00, 50:27) | 33:00 (24:00, 50:48) | 0.76 |
Male, % (n) | 40.6% (564) | 27.0% (20) | 41.4% (544) | 0.02 |
Emergency, % (n) | 15.4% (214) | 9.5% (7) | 15.7% (207) | 0.15 |
Success rate, % (n) | 89.4% (1242) | 89.2% (66) | 89.4% (1176) | 0.95 |
Periampullary diverticulum, % (n) | 11.5% (160) | 28.4% (21) | 10.6% (139) | <0.001 |
Sphincterotomy, % (n) | 58.5% (813) | 68.9% (51) | 57.9% (762) | 0.06 |
Rectal indomethacin, % (n) | 27.3% (379) | 28.4% (21) | 27.2% (358) | 0.83 |
Stent placement, % (n) | 73.5% (1020) | 74.3% (55) | 73.4% (965) | 0.87 |
Ethnicity |
||||
Caucasian (not Jewish or Hispanic) | 34.8% (484) | 36.5% (27) | 34.8% (457) | |
Jewish | 27.6% (383) | 51.4% (38) | 26.2% (345) | |
African American | 5.3% (73) | 1.4% (1) | 5.5% (72) | |
Asian | 19.8% (275) | 10.8% (8) | 20.3% (267) | |
South Asian | 1.4% (20) | - | 1.5% (20) | |
Hispanic | 3.3% (46) | - | 3.5% (46) | |
Native American | 0.8% (11) | - | 0.8% (11) | |
Middle Eastern | 4.1% (57) | - | 4.3% (57) | |
Other/No response | 2.8% (40) | - | 3.0% (40) | |
Comorbidities | ||||
Coronary artery disease | 6.7% (93) | 6.8% (5) | 6.7% (88) | 1 |
Congestive heart failure | 5.8% (81) | 18.9% (14) | 5.1% (67) | <0.001 |
Chronic obstructive pulmonary disease | 3.7% (51) | 8.1% (6) | 3.4% (45) | 0.05 |
Chronic kidney disease | 3.0% (41) | 8.1% (6) | 2.7% (35) | 0.019 |
Cerebrovascular accident | 3.2% (45) | 8.1% (6) | 3.0% (39) | 0.029 |
Diabetes mellitus | 25% (347) | 20.3% (15) | 25.2% (332) | 0.336 |
Hypertension | 50.6% (703) | 73.0% (54) | 49.4% (649) | <0.001 |
Peripheral vascular disease | 1.2% (17) | 4.1% (3) | 1.1% (14) | 0.058 |
Dementia | 2.7% (37) | 16.2% (12) | 1.9% (25) | <0.001 |
Peptic ulcer disease | 4.2% (58) | 5.4% (4) | 4.1% (54) | 0.546 |
Indications | ||||
Biliary stones | 50.9% (707) | 60.8% (45) | 50.3% (662) | 0.004 |
Cholangitis | 17.0% (236) | 24.3% (18) | 16.6% (218) | 0.004 |
Abnormal imaging/mass | 32.1% (446) | 14.9% (11) | 33.1% (435) | 0.004 |
Outcomes | ||||
In-patient mortality, % (n) | 2.2% (30) | 12.2% (9) | 1.6% (21) | <0.001 |
Overall adverse event rate | 7.0% (97) | 4.1% (3) | 7.1% (94) | 0.31 |
Individual adverse events |
||||
Minor adverse event rate | 5.0% (69) | 4.1% (3) | 5.0% (66) | |
Major adverse event rate | 2.0% (28) | - | 2.1% (28) | |
Minor bleeding | 1.2% (16) | 1.4% (1) | 1.1% (15) | |
Fever | 1.7% (23) | 1.4% (1) | 1.7% (22) | |
Post-ERCP pancreatitis | 2.2% (30) | 1.4% (1) | 2.2% (29) | |
Mucosal injuries | 0.1% (1) | - | 0.1% (1) | |
Bleeding requiring transfusion | 1.2% (16) | - | 1.2% (16) | |
Bleeding requiring intervention | 0.6% (8) | - | 0.6% (8) | |
Perforation | 0.2% (3) | - | 0.2% (3) |
Adjusted odds ratio | 95% Confidence interval |
p-value | ||
---|---|---|---|---|
Lower | Upper | |||
Adverse events | ||||
Emergency procedure | 2.45 | 1.49 | 4.03 | <0.001 |
CCI ≥2 | 2.58 | 1.66 | 4.00 | <0.001 |
Age ≥90 | 0.52 | 0.16 | 1.70 | 0.28 |
Cholangitis |
0.49 | 0.27 | 0.91 | 0.02 |
Abnormal imaging/mass |
0.35 | 0.20 | 0.62 | 0.35 |
Mortality | ||||
Emergency procedure | 0.72 | 0.23 | 2.23 | 0.57 |
CCI ≥2 | 2.44 | 1.15 | 5.20 | 0.02 |
Age ≥90 | 9.58 | 4.00 | 22.98 | <0.001 |
Cholangitis |
3.98 | 1.42 | 11.20 | 0.01 |
Abnormal imaging/mass |
3.26 | 1.23 | 8.62 | 0.02 |
Year | Region | No. of procedures/patients |
Success rate |
Adverse event rate |
Mortality rate |
|||||
---|---|---|---|---|---|---|---|---|---|---|
≥90 | <90 | ≥90 | <90 | ≥90 | <90 | ≥90 | <90 | |||
Sugiyama et al. [16] | 2000 | Japan | 22 | 381 | 100.0% | 98.4% | 4.5% | 6.8% | 0% | 0.3% |
Rodríguez-González et al. [15] | 2003 | Spain | 126 | - | 90.5% | - | 2.5% | - | 0.7% | - |
Mitchell et al. [14] | 2003 | Ireland | 23 | - | 91.3% | - | 13.0% | - | 13% |
- |
Hui et al. [12] |
2004 | Hong Kong | 64 | 165 | 98.4% | 92.7% | 4.7% | 7.3% | 7.8% |
4.2% |
Huguet et al. [11] | 2005 | Spain | 42 | - | 85.7% | - | 14.4% | - | 0% | - |
Katsinelos et al. [13] | 2006 | Greece | 63 | 350 | 98.4% | 99.1% | 6.3% | 8.4% | 1.6% | 0.6% |
Cariani et al. [8] | 2006 | Italy | 40 | - | 82.0% | - | 0.0% | - | 0% | - |
Grönroos et al. [9] | 2010 | Finland | 41 | - | - | - | 7.0% | - | 10% |
|
Hu et al. [10] | 2014 | China | 78 | 312 | 91.0% | 96.2% | 7.7% | 7.4% | - | - |
Yun et al. [17] | 2014 | Korea | 43 | 129 | 86.0% | 94.0% | 12.0% | 22.0% | 2% | 0% |
This study | US | 74 | 1,315 | 89.2% | 89.4% | 4.1% | 7.1% | 12.2% |
1.6% |
IQR, interquartile range; ERCP, endoscopic retrograde cholangiopancreatography. Independent sample Mann–Whitney Pearson chi-squared test. Fisher’s exact test. Cell sizes are too small for analyses.
CCI, Charlson comorbidity index. Biliary stone disease was considered as the reference constant.
ERCP, endoscopic retrograde cholangiopancreatography. All-cause in-patient mortality. Thirty-day mortality. All patients underwent the procedure for cholangitis. Early mortality, unclear definition.