Diagnosis and treatment of biliary obstruction in the elderly

Abstract

Background: Introduction: biliary obstruction in the elderly is evidenced by a variety of clinical symptoms and imaging characterizations, making it difficult to diagnose and treat.
Objective: analyze the prevalence of biliary obstruction causes, diagnosis techniques, and treatment; detect prognostic factors for neoplastic biliary obstruction; and create a predictive score of Neoplastic Biliary Obstruction in elderly patients (NeBO).
Materials and methods: observational prospective cross-sectional study. Sixty one ≥65 years old pa- tients with biliary obstruction were studied. 
Results: 34% showed neoplastic diseases, and 63% showed lithiasic disease. Abdominal ultrasound with a 69% sensitivity of for bile duct dilatation, and 29% for cholelithiasis were conducted. 25% of patients underwent a computed tomography, and 18% underwent a cholangio resonance. 79% of patients underwent diagnostic and/or therapeutic ERCP, with a morbidity rate of 31% and a mortality rate of 4%. Anemia at baseline and direct bilirubin over 7 mg/dL were independent predictors of ma- lignant biliary obstruction in the multivariate analysis. NeBO showed a 94.91% of pre-test probability.
Conclusion: lithiasis is the most prevalent cause. Complementary studies showed lower sensitivity and specificity than other studies. ERCP showed higher complication rates than other exams. A prognostic score for neoplastic biliary obstruction in elderly patients was created.