Complicaciones de la colangiopancreatografía retrógrada endoscópica en pacientes mayores de 90 años / Complications of endoscopic retrograde cholangiopancreatography in patients aged more than 90 years old

Introducción: El objetivo del presente estudio ha sido valorar la eficacia y la tasa de complicaciones tras la realización de la colangiopancreatografía retrógrada endoscópica (CPRE) en pacientes mayores de 90 años. Pacientes y método: Estudio de tipo descriptivo realizado desde el 1 de enero de 2001 hasta el 1 de junio de 2004 en el que se han recogido de forma prospectiva un total de 42 exploraciones endoscópicas realizadas a 36 pacientes (7 varones y 29 mujeres) con una edad media de 91 años (rango: 90-96 años). A todos los pacientes se les aplicó el siguiente seguimiento: a) valoración clínica antes y después de la realización de la técnica; b) consideración de éxito o fracaso de la técnica, y c) valoración de complicaciones (perforación, hemorragia, pancreatitis e infección). Se valoró la coexistencia de enfermedades asociadas así como la presencia de alteraciones anatómicas de la papila (divertículos duodenales). Resultados: Se consiguió el éxito de la CPRE en el 85,7% de las exploraciones. Un total de 23 pacientes (63,8%) presentaban una o más enfermedades mayores asociadas. En 15 pacientes (33,3%) la papila se encontraba asociada a un divertículo duodenal. El índice de complicaciones fue en conjunto el siguiente: pancreatitis aguda en 2 de las 42 exploraciones (4,7%), una de las cuales fue leve (2,35%) y la otra moderada (2,35%); hemorragia postesfinterotomía en el 2,8% de los pacientes (1/35); bacteriemia en una de las 42 exploraciones (un 2,3% de los pacientes), y otro caso de colangitis (2,3%), sin que hubiera ninguno de colecistitis secundaria, e hipoxemia en un caso. No hubo ninguna perforación ni fallecimiento en relación con la prueba. Conclusión: La CPRE es una técnica eficaz y segura con una baja tasa de morbilidad en pacientes de edad avanzada

Introduction: To evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) and the complication rates of this procedure in patients aged 90 years and older. Patients and method: A descriptive, prospective study including 42 endoscopic procedures performed from first January 2001 until first June 2004 in 36 patients (7 males and 29 females) was performed. The mean age was 91 years (range 90-96 years). All patients underwent the following: a) clinical evaluation before and after endoscopic exploration; b) evaluation of the success or failure of the endoscopic procedure and c) assessment of complications (perforation, hemorrhage, pancreatitis and infection). Concurrent associated illnesses, as well as the existence of anatomical alterations in Vater’s papilla (duodenal diverticula), were also evaluated. Results: ERCP was successful in 85.7% of all explorations performed. Twenty-three patients (63.8%) had one or more major associated diseases. In 15 patients (33.3%) Vater’s papilla was associated with duodenal diverticula. The complication rates were as follows: 1) acute pancreatitis in 2 explorations (4.7%), one mild (2.35%) and the other moderate (2.35%); 2) hemorrhage after endoscopic sphincterotomy in 2.8% of patients (1/35); 3) bacteriemia in one patient (2.3%) and cholangitis in one patient (2.3%), with no cases of secondary cholecystitis; 4) hypoxemia in one patient. There were no perforations or deaths related to the procedure. Conclusion: ERCP is a safe and effective technique with a low complication rate in patients aged 90 years or older

Validation of a modified version of the Gijon's social-familial evaluation scale (SFES): the "Barcelona SFES Version", for patients with cognitive impairment.

The aim was to validate an abbreviated version of the Gijon's social-familial evaluation scale (SFES) (Barcelona-SFES version), on patients with cognitive impairment. A group of 34 patients with cognitive impairment, admitted to an intermediate-long-term-care facility, were analyzed. Mean age was 80.2 +/- 7.4 years. Gijón's SFES was abbreviated and only the first three item groups corresponding to family conditions, social contacts and assistance from the social network were selected. Barcelona-SFES version had a range score between 3 to 15 points, in which low scores identify older patients who live with their family, have good contacts, and participate in community activities. In contrast, high scores identify older persons who live alone and have poor social support and little participation with community activities. Three social risk categories were established according to the Barcelona-SFES score: low social risk (>/= 7 points), intermediate social risk (8-9 points) and high social points). Validation criteria used in the present study were: predictive value of Barcelona-SFES score of post-discharge destination (home or institution), and patient's (or family's) request for a definitive institutionalization in a nursing home. There were 9 patients with low social risk (26.4 %), 8 with intermediate social risk (23.5 %) and 17 with high social risk (50 %). A significant relationship between Barcelona-SFES scores and post-discharge destination was found. Eighty percent of patients discharged to an institution(nursing and residential homes), they had high social risk SFES scores (>/= 10) Also, a significant correlation was found between the number of patients for which a definitive institutionalization request was performed and the Barcelona-SFES scores. Fifteen (88.2 %) of the 18 patients for whom the request was done, were in the high social risk group. The lowest scores from SFES were predictive of home discharge, while the highest scores were predictive of a definitive institutionalization.

Prevalence of delirium in a geriatric convalescence hospitalization unit: patient's clinical characteristics and risk precipitating factor analysis.

The aim was to evaluate the prevalence of delirium among patients discharged from an acute care hospital and admitted to a geriatric convalescence unit (GCU), and to analyze patient's characteristics and risk precipitating factors. Sixty-eight patients were analyzed during a 2-week period. The confusion assessment method (CAM) was used to detect delirium. The precipitating factors evaluated were: major surgery-intensive care unit(ICU) stay, pulmonary and heart failure, acute infections, metabolic disorders/anemia,psychoactive medications, other drugs, severe pain, changing environmental influences and others. According to CAM, fifteen patients presented delirium (22%), and in 14 of them(93.3 %) the delirium was developed before admission at GCU. The precipitating factors in the studied population were the following: changing environmental influences in 66 patients(97%) (15 with delirium and 51 without delirium); other drugs 56 (82.3 %) (11 vs. 45);others 56 (82.3%) (9 vs. 24); psychoactive medications 50 (73.5%) (12 vs. 38); acute infections 48 (70.5 %) (13 vs. 35); metabolic disorders/anemia 40 (58.8 %) (9 vs. 31); major surgery-ICU stay 28 (41 .1%) (8 vs. 20); severe pain 26 (38.2%) (6 vs. 20); pulmonary and heart failure 22 (32.3%) (5 vs. 17). The univariant analysis showed that, none of the precipitating factors studied was significantly related to delirium. Seventy-two patients (91.1%) had simultaneously >3 precipitating factors. There were 16 patients with >6 precipitating factors, 7 of 15 with delirium and 9 of the 53 without delirium (46.6 % vs 16.9 %) (p < 0.05). The prevalence of delirium has been 22 %. Most of the patients had developed delirium before the admission at GCU. A high proportion of patients had >3 precipitating factors. In the study the presence of > 6 precipitating factors simultaneously has been significantly related to delirium.