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Mo1438 Needle Knife Precut Sphincterotomy Is a Safe Method in Elderly Patients
Abstracts
dilation, cholangioscopy, and plastic stent placement were associated with higher radiation exposure. Furthermore, ERCP procedures that are moderately difficult, very difficult, involve magnification or high resolution images also lead to higher radiation exposure. Special care should be taken in these settings to minimize radiation exposure to both the patient and endoscopists. Table 1. Risk Factors for ERCP Radiation (Fluoroscopy Time) by Multivariate Analysis Indication CBD Stone CBD Stricture Pancreatic Stricture Cholangitis SOD Ampullary Neoplasm Procedure Balloon Sweep Sphincterotomy Dilation Cholangioscopy Plastic Stent Characteristic Moderately difficult Very difficult Magnification used Hires image taken
Parameter Estimate
t-value
p-value
-29.19 137.73370 121.90852 -94.06 -44.52257 -50.39404
40.75 3.25 1.59 -1.41 -0.67 -0.66
0.47 0.0014 0.1131 0.1592 0.5067 0.5127
-67.96689 -52.60458 182.06995 129.80608 78.92278
-1.90 -1.61 4.56 2.23 2.30
0.0587 0.1097 !0.0001 0.0268 0.0224
146.58358 332.81081 146.05957 90.29533
4.39 7.13 3.70 2.56
!0.0001 !0.0001 0.0003 0.0111
CBD, common bile duct; SOD, Sphincter of Oddi dysfunction
Table 2. Risk Factors for ERCP Radiation (Fluoroscopy Air Kerma
Reference Dose) by Multivariate Analysis Indication CBD Stone CBD Stricture Pancreatic Stricture Cholangitis SOD Ampullary Neoplasm Procedure Balloon Sweep Sphincterotomy Dilation Cholangioscopy Plastic Stent Characteristic Moderately difficult Very difficult Magnification used Hires image taken
Parameter Estimate
t-value
p-value
-1.14013 8.66835 11.23683 -5.13157 -5.22614 -1.37007
-0.39 2.88 2.06 -1.08 -1.10 -0.25
0.6950 0.0045 0.0408 0.2804 0.2743 0.8026
-4.82126 -3.33534 10.18653 7.23292 3.63191
-1.82 -1.38 3.45 1.68 1.43
0.0700 0.1704 0.0007 0.0947 0.1539
9.94 16.80 9.98 7.43
2.48 3.47 2.93 2.62
!0.0001 !0.0001 0.0008 0.005
nZ41,144) and 63.5 % (nZ38,940) had a comorbidity index of at least 2. Most of the admissions were classified as emergent (64.5 %, nZ34,600). The ERCP was usually performed at a large (67.7 %, nZ 41,382), urban (93.1 %, nZ56,889) hospital. The leading payer source was Medicare (91.7 %, nZ 56,182). The mean length of stay was 7.1 days (SE 0.08) with an in-hospital mortality of 3.1 % (nZ1,919). The primary discharge diagnosis was most often biliary stone disease (31.4 %, nZ19,225). 45.0% (nZ27,609) of patients had a diagnosis of any infection. Infection was associated with a significantly higher risk of in-hospital mortality (OR 2.8, 95% CI 2.1-3.7, p ! 0.001). Conclusion: ERCP is now routinely being performed during inpatient admissions for octogenarians with diseases of the biliary tract. The mortality of octogenarians undergoing inpatient ERCP is higher than previous reports and is likely due to superimposed infection during the same admission.
Mo1438 Needle Knife Precut Sphincterotomy Is a Safe Method in Elderly Patients Irfan Koruk*, Musa Aydinli, Cemil M. Savas, Mehmet Koruk Gastroenterology, Gaziantep University Medical School, Gaziantep, Turkey Introduction: Needle knife precut sphincterotomy (NKP) is one of the methods for difficult cannulation. The complication rate is higher in non-experienced hands. Also it is supposed to be higher in elderly patients. The aim of the study is to define if precut sphincterotomy is safe or not in elderly patients (over age 65). Aims&Methods: The aim of the study is to define if precut sphincterotomy is safe or not in elderly patients. 418 patients undergone ERCP in one-year period were evaluated. The same endoscopist did all the procedures. The demographic variables, total procedure time, cannulation technique, outcomes and complications were recorded prospectively. Results: Mean age of total 418 patients was 54.9 17.9 (13-99) years. 132 of them (31.5%) were 65 years and older. Of these 132 elderly patients (56M/76F) mean age was 74.67.1 years. 76 procedures (57.6%) were done for common bile duct stones, 23 (17.4%) for malignant disease, and remaining (25%) for other reasons. After attempts of standard cannulation techniques for 5 minutes if deep biliary cannulation is not achieved then NKP was applied. The NKP was started from the orifis to the top. In 103 of 132 patients (78%) ERCP was applied with standart techniques (ST). In 29 patients (22%) cannulation was achieved with NKP. Deep cannulation was achieved in 100/103 patients with ST and in all patients in the NKP group. Mean procedure time was 159.1 minutes (14.59.5 in ST and 176.9 in NKP groups). There was one minor hemorrhage (no need for endoscopic therapy) and one pancreatitis in ST group and one cholangitis and no pancreatitis in NKP group. The overall complication rates were not statistically different (1.5 vs 3.4% respectively, pZ0.249). Conclusion: NKP is an advanced cannulation technique. It has a long learning curve and is safe in experienced hands. Timing of the NKP is important and may play a role on post ERCP complications. Prolonged cannulation attempts may increase the complication rate. In this study we can conclude that with adequate timing and experience, needle knife precut sphincterotomy is a safe method in elderly patients.
CBD, common bile duct; SOD, Sphincter of Oddi dysfunction
Mo1437 ERCP in Octogenarians: a Population Based Study Using the Nationwide Inpatient Sample Adam W. Coe*3, Clancy J. Clark1, Nora Fitzgerald2, Rishi Pawa3 1 General Surgery, Wake Forest Baptist Health, Winston Salem, NC; 2 Public Health Sciences, Wake Forest Baptist Health, Winston Salem, NC; 3 Gastroenterology, Wake Forest Baptist Health, Winston Salem, NC Background: In the elderly population, there is a growing demand for minimally invasive procedures as the incidence of pancreaticobiliary disease increases with age. Endoscopic Retrograde Cholangiopancreatography (ERCP) is now widely available and has proven utility in the management of biliary tract disease. Patients with advanced age offer unique challenges for any procedure as they also tend to have a higher rate of baseline comorbidities and malignancy. The aim of the current study was to characterize the mortality and length of stay of octogenarians undergoing inpatient ERCP. Methods: Using the 2007-2010 Nationwide Inpatient Sample (NIS), we performed a retrospective analysis of health related outcomes among 80 to 89 year old patients undergoing inpatient ERCP. Surgical patients were excluded. Results: An estimated 61,322 octogenarians underwent inpatient ERCP in the United States from 2007 to 2010. The mean age was 84.2 (SE 0.02) with 59.5 % (nZ36,460) of the patients being female. A large majority of the patients were Caucasian (79. %,
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Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB419
dilation, cholangioscopy, and plastic stent placement were associated with higher radiation exposure. Furthermore, ERCP procedures that are moderately difficult, very difficult, involve magnification or high resolution images also lead to higher radiation exposure. Special care should be taken in these settings to minimize radiation exposure to both the patient and endoscopists. Table 1. Risk Factors for ERCP Radiation (Fluoroscopy Time) by Multivariate Analysis Indication CBD Stone CBD Stricture Pancreatic Stricture Cholangitis SOD Ampullary Neoplasm Procedure Balloon Sweep Sphincterotomy Dilation Cholangioscopy Plastic Stent Characteristic Moderately difficult Very difficult Magnification used Hires image taken
Parameter Estimate
t-value
p-value
-29.19 137.73370 121.90852 -94.06 -44.52257 -50.39404
40.75 3.25 1.59 -1.41 -0.67 -0.66
0.47 0.0014 0.1131 0.1592 0.5067 0.5127
-67.96689 -52.60458 182.06995 129.80608 78.92278
-1.90 -1.61 4.56 2.23 2.30
0.0587 0.1097 !0.0001 0.0268 0.0224
146.58358 332.81081 146.05957 90.29533
4.39 7.13 3.70 2.56
!0.0001 !0.0001 0.0003 0.0111
CBD, common bile duct; SOD, Sphincter of Oddi dysfunction
Table 2. Risk Factors for ERCP Radiation (Fluoroscopy Air Kerma
Reference Dose) by Multivariate Analysis Indication CBD Stone CBD Stricture Pancreatic Stricture Cholangitis SOD Ampullary Neoplasm Procedure Balloon Sweep Sphincterotomy Dilation Cholangioscopy Plastic Stent Characteristic Moderately difficult Very difficult Magnification used Hires image taken
Parameter Estimate
t-value
p-value
-1.14013 8.66835 11.23683 -5.13157 -5.22614 -1.37007
-0.39 2.88 2.06 -1.08 -1.10 -0.25
0.6950 0.0045 0.0408 0.2804 0.2743 0.8026
-4.82126 -3.33534 10.18653 7.23292 3.63191
-1.82 -1.38 3.45 1.68 1.43
0.0700 0.1704 0.0007 0.0947 0.1539
9.94 16.80 9.98 7.43
2.48 3.47 2.93 2.62
!0.0001 !0.0001 0.0008 0.005
nZ41,144) and 63.5 % (nZ38,940) had a comorbidity index of at least 2. Most of the admissions were classified as emergent (64.5 %, nZ34,600). The ERCP was usually performed at a large (67.7 %, nZ 41,382), urban (93.1 %, nZ56,889) hospital. The leading payer source was Medicare (91.7 %, nZ 56,182). The mean length of stay was 7.1 days (SE 0.08) with an in-hospital mortality of 3.1 % (nZ1,919). The primary discharge diagnosis was most often biliary stone disease (31.4 %, nZ19,225). 45.0% (nZ27,609) of patients had a diagnosis of any infection. Infection was associated with a significantly higher risk of in-hospital mortality (OR 2.8, 95% CI 2.1-3.7, p ! 0.001). Conclusion: ERCP is now routinely being performed during inpatient admissions for octogenarians with diseases of the biliary tract. The mortality of octogenarians undergoing inpatient ERCP is higher than previous reports and is likely due to superimposed infection during the same admission.
Mo1438 Needle Knife Precut Sphincterotomy Is a Safe Method in Elderly Patients Irfan Koruk*, Musa Aydinli, Cemil M. Savas, Mehmet Koruk Gastroenterology, Gaziantep University Medical School, Gaziantep, Turkey Introduction: Needle knife precut sphincterotomy (NKP) is one of the methods for difficult cannulation. The complication rate is higher in non-experienced hands. Also it is supposed to be higher in elderly patients. The aim of the study is to define if precut sphincterotomy is safe or not in elderly patients (over age 65). Aims&Methods: The aim of the study is to define if precut sphincterotomy is safe or not in elderly patients. 418 patients undergone ERCP in one-year period were evaluated. The same endoscopist did all the procedures. The demographic variables, total procedure time, cannulation technique, outcomes and complications were recorded prospectively. Results: Mean age of total 418 patients was 54.9 17.9 (13-99) years. 132 of them (31.5%) were 65 years and older. Of these 132 elderly patients (56M/76F) mean age was 74.67.1 years. 76 procedures (57.6%) were done for common bile duct stones, 23 (17.4%) for malignant disease, and remaining (25%) for other reasons. After attempts of standard cannulation techniques for 5 minutes if deep biliary cannulation is not achieved then NKP was applied. The NKP was started from the orifis to the top. In 103 of 132 patients (78%) ERCP was applied with standart techniques (ST). In 29 patients (22%) cannulation was achieved with NKP. Deep cannulation was achieved in 100/103 patients with ST and in all patients in the NKP group. Mean procedure time was 159.1 minutes (14.59.5 in ST and 176.9 in NKP groups). There was one minor hemorrhage (no need for endoscopic therapy) and one pancreatitis in ST group and one cholangitis and no pancreatitis in NKP group. The overall complication rates were not statistically different (1.5 vs 3.4% respectively, pZ0.249). Conclusion: NKP is an advanced cannulation technique. It has a long learning curve and is safe in experienced hands. Timing of the NKP is important and may play a role on post ERCP complications. Prolonged cannulation attempts may increase the complication rate. In this study we can conclude that with adequate timing and experience, needle knife precut sphincterotomy is a safe method in elderly patients.
CBD, common bile duct; SOD, Sphincter of Oddi dysfunction
Mo1437 ERCP in Octogenarians: a Population Based Study Using the Nationwide Inpatient Sample Adam W. Coe*3, Clancy J. Clark1, Nora Fitzgerald2, Rishi Pawa3 1 General Surgery, Wake Forest Baptist Health, Winston Salem, NC; 2 Public Health Sciences, Wake Forest Baptist Health, Winston Salem, NC; 3 Gastroenterology, Wake Forest Baptist Health, Winston Salem, NC Background: In the elderly population, there is a growing demand for minimally invasive procedures as the incidence of pancreaticobiliary disease increases with age. Endoscopic Retrograde Cholangiopancreatography (ERCP) is now widely available and has proven utility in the management of biliary tract disease. Patients with advanced age offer unique challenges for any procedure as they also tend to have a higher rate of baseline comorbidities and malignancy. The aim of the current study was to characterize the mortality and length of stay of octogenarians undergoing inpatient ERCP. Methods: Using the 2007-2010 Nationwide Inpatient Sample (NIS), we performed a retrospective analysis of health related outcomes among 80 to 89 year old patients undergoing inpatient ERCP. Surgical patients were excluded. Results: An estimated 61,322 octogenarians underwent inpatient ERCP in the United States from 2007 to 2010. The mean age was 84.2 (SE 0.02) with 59.5 % (nZ36,460) of the patients being female. A large majority of the patients were Caucasian (79. %,
www.giejournal.org
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB419