A retrospective study of the safety and efficacy of ERCP in octogenarians.

BACKGROUND: Pancreatobiliary disease is increased in elderly patients. Because of significant comorbidities, these patients may be at greater risk of developing complications related to endoscopic retrograde cholangiopantreatography (ERCP). OBJECTIVE: The purpose of this study was to compare the indications, interventions, and complications of ERCP of octogenarians with nonoctogenarians. METHODS: A retrospective review of patient records from a single tertiary care hospital was performed. Adult patients undergoing ERCP were divided into two groups according to age. Group 1 patients were of age < 80 years (N = 391), and group 2 patients were > 80 years of age (N = 102). Indications, therapeutic interventions, use of conscious sedation, duration of procedure and complications were retrieved from the patient records. Main outcome measurements included: indications, therapeutic interventions, use of conscious sedation, duration of procedure and complications. RESULTS: There was an increase in sphincterotomy rates (74 vs 63%; P < 0.05) and stent insertions (48 vs 29%; P < 0.001) in the octogenarian group. In group 1 there were 19 cases (4.9%) of post ERCP pancreatitis who spent 251 hospital days (including 59 ICU days) compared with one case (0.98%) in group 2 who required ten hospital days (P < 0.05) and 0 ICU days. Procedure time for octogenarians was greater than nonoctogenarians (33.1 vs 29.8 min; P < 0.05). Octogenarians required less conscious sedation than nonoctogenarians (midazolam 4.1 vs 5.9 mg; P < 0.05 and fentanyl 45.5 vs 80.4 mcg; P < 0.05). CONCLUSIONS: In octogenarians, ERCP is efficacious and safe. It is associated with a lower rate of hospitalization for pancreatitis. ERCP in octogenarians takes longer, is associated with increased interventions (stent insertion and sphincterotomy) and requires less sedation.

Intermittent advanced atrial depolarization abnormality?

Abnormal atrial depolarization, characterized by P waves > or =110 ms on the electrocardiogram, can manifest as partial or advanced interatrial block (IAB). Advanced IAB, denoted by biphasic P waves in leads II, II and aVF, is considered to confer increased severity in interatrial conduction delay, and is now perceived to be a result of continued deterioration in interatrial impulse propagation between the atria. While progression from partial to advanced IAB has been described, the converse, resolution of advanced IAB, which has often been touted as 'complete block' to its partial, 'incomplete' type, i.e. the occurrence of intermittent advanced IAB, has escaped observations so far. We present the first known report of such a scenario.