超高齢者における総胆管結石内視鏡治療の検討

Background/Aims: The prevalence of common bile duct stones is known to increase with age, as evident in the number of older adults >90 years who have this condition. Although several studies on endoscopic treatment for common bile duct stones in older adults have been reported, few studies have examined patients aged >90 years. We aimed to evaluate the efficacy and safety of endoscopic therapy for patients in the said age group. Methods: We retrospectively collected data of 86 patients (>90 years old) who have attempted endoscopic treatment at two institutions—Toyama Red Cross Hospital and Itoigawa General Hospital—between April 2015 and March 2022. We compared the efficacy and safety of endoscopic stone removal with those of permanent biliary stenting by assessing the incidence of adverse events (AEs) and rate of cholangitis recurrence. Results: Of the 86 patients, 56 had undergone complete endoscopic stone removal and 30 had undergone permanent biliary stenting. Three (5.3%) patients in the stone removal group and one (3.3%) patient in the biliary stenting group experienced early AEs, with no significant differences between the groups. Recurrent cholangitis happened more frequently in the biliary stenting group (43.3%) than in the endoscopic stone removal group (10.7%; P = 0.001). Two patients died of cholangitis. Conclusions: In older adults >90 years who can be treated endoscopic therapy, it is better to attempt complete endoscopic stone removal for bile duct stone treatment, instead of just biliary stenting.