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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2022; 14(4): 215-225
Published online Apr 16, 2022. doi: 10.4253/wjge.v14.i4.215
Endoscopic retrograde cholangiopancreatography for bile duct stones in patients with a performance status score of 3 or 4
Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
Hirokazu Saito, Shuji Tada, Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Japan
Yoshihiro Kadono, Department of Gastroenterology, Tsuruta Hospital, Kumamoto City 862-0925, Japan
Takashi Shono, Ikuo Matsushita, Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
Kentaro Kamikawa, Atsushi Urata, Haruo Imamura, Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
Jiro Nasu, Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
Tatsuyuki Kakuma, Department of Biostatics, Kurume University, Kurume City 8300011, Japan
Author contributions: Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, and Tada S have been equally involved and have read and approved the final manuscript; Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, and Tada S meet the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the reported results.
Institutional review board statement: The institutional review boards of the participating institutions approved this study.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest in relation to this article.
Data sharing statement: No additional data are available.
STROBE statement: All the authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hirokazu Saito, MD, Doctor, Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City 862-8505, Japan. arnestwest@yahoo.co.jp
Received: November 17, 2021
Peer-review started: November 17, 2021
First decision: January 12, 2022
Revised: January 22, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: April 16, 2022
BACKGROUND
As the aging population grows worldwide, the rates of endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones (CBDS) in older patients with a poor performance status (PS) have been increasing. However, the data on the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4 are lacking, with only a few studies having investigated this issue among patients with poor PS.
AIM
To examine the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4.
METHODS
This study utilized a retrospective multi-centered design of three institutions in Japan for 8 years to identify a total of 1343 patients with CBDS having native papillae who underwent therapeutic ERCP. As a result, 1113 patients with a PS 0-2 and 230 patients with a PS 3-4 were included. One-to-one propensity-score matching was performed to compare the safety and efficacy of ERCP for CBDS between patients with a PS 0-2 and those with a PS 3-4.
RESULTS
The overall ERCP-related complication rates in all patients and propensity score-matched patients with a PS 0-2 and 3-4 were 9.0% (100/1113) and 7.0% (16/230; P = 0.37), and 4.6% (9/196) and 6.6% (13/196; P = 0.51), respectively. In the propensity score-matched patients, complications were significantly more severe in the group with a PS 3-4 than in the group with a PS 0-2 group (P = 0.042). Risk factors for complications were indications of ERCP and absence of antibiotics in the multivariate analysis. Therapeutic success rates, including complete CBDS removal and permanent biliary stent placement, in propensity score-matched patients with a PS 0-2 and 3-4 were 97.4% (191/196) and 97.4% (191/196), respectively (P = 1.0).
CONCLUSION
ERCP for CBDS can be effectively performed in patients with a PS 3 or 4. Nevertheless, the indication for ERCP in such patients should be carefully considered with prophylactic antibiotics.
Core Tip: In 196 propensity-matched patients, the overall complications and technical success in patients with a performance status (PS) 3 or 4 were comparable to those of patients with a PS 0-2. However, complications were more severe in patients with a PS 3 or 4. In the multivariate analysis, indications of endoscopic retrograde cholangiopancreatography (ERCP) and the absence of antibiotics were significant risk factors for complications. Although ERCP for common bile duct stones can be effectively performed in patients with a PS 3 or 4, the indication for ERCP should be carefully considered, and prophylactic antibiotics should be administered to patients with a PS 3 or 4.
