Interval percutaneous cholecystostomy is effective for decompression of the common bile duct in high-risk elderly patients prior to endoscopic retrograde cholangiopancreatography.

ABSTRACT

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for common bile duct decompression. Nevertheless, this procedure may be hazardous for high-risk elderly patients. OBJECTIVE: To assess retrospectively whether interval percutaneous cholecystostomy (PC) should be considered in high-risk patients until their condition has improved and allows ERCP to be performed. SETTING: Referral community teaching hospital. PATIENTS 8 elderly high-risk patients with acute cholangitis. INTERVENTION All underwent PC as a bridging procedure till performing ERCP. RESULTS: Age ranged from 72 to 91 years (median 87). All 8 patients underwent PC. PC insertion improved their general condition and allowed us to perform an ERCP later on. Median time between PC and ERCP was 5 days. In 3 patients there was no need to perform an ERCP. All were discharged in a generally good condition and after normalization of bilirubin and liver enzymes. Median length of stay in hospital was 18 days. CONCLUSIONS: PC, as a bridging procedure to ERCP, can be an appropriate approach for selective high-risk elderly patients in whom ERCP is considered to be difficult and hazardous at the time of presentation.