Outcome Analysis of Palliative Endoscopic Biliary Stenting (EBS) for Frail Elderly Patients Aged 80 Years and Above With Choledocholithiasis

OBJECTIVES: This study aims to retrospectively analyse the outcome of palliative endoscopic biliary stenting (EBS) in very elderly patients aged 80 years and above with choledocholithiasis. METHODS: Between September 2017 and January 2022, the endoscopy unit at Universiti Malaya Medical Centre (UMMC) conducted 85 ERCP procedures on patients aged 80 and above, who had been diagnosed with choledocholithiasis. The study sample was narrowed down to 11 patients who had received palliative EBS after excluding cases where stone removal was done and patients undergoing active management. Information regarding the patients' medical records, including their past medical history, details of the endoscopic retrograde cholangiopancreatography (ERCP) procedure with palliative EBS, and their subsequent follow-up records, was gathered from the UMMC electronic medical record. RESULTS: Out of the 11 patients included in the study, six patients (54.44%) experienced recurrent cholangitis, with a median interval of 534 days from the date of index ERCP to the onset of the first recurrence. Two of the six patients (33.33%) who experienced recurrence were able to achieve stone clearance after undergoing repeat ERCP. Among the five patients who remained recurrence-free, the median follow-up duration was 120 days. In addition, out of the study cohort, seven patients (63.64%) passed away during the follow-up period, with only one patient (14.29%) dying due to recurrent cholangitis, while the other six patients (85.71%) died of their co-morbidities. CONCLUSION: ERCP with palliative EBS can be a feasible alternative for very elderly patients with complex medical issues; however, it is imperative to ensure close follow-up and careful monitoring during the post-treatment period.