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Chirurgie 2. März 2016

Cholecystectomy in patients aged 80 years and more following ERCP: is it necessary?

Background: Long-term outcome in patients aged 80 years and more found that they had common bile duct (CBD) stones at endoscopic retrograde cholangiopancreatography (ERCP) managed under “wait and watch” policy without cholecystectomy.

Methods: Retrospective analysis was done of a prospectively maintained database and healthcare records on all patients who underwent ERCP between February 2007 and December 2009 in a university teaching hospital. Those found to have gall stones with CBD stones were included in this study. Patients were followed up for 8 years until March 2015.

Results: A total of 113 consecutive patients with stones in CBD were retrieved. Mean age (range) was 85 years (80–97); there were 71 female and 42 male patients. Six patients died during the same admission, five due to ongoing cholangitis and one due to pneumonia. Of the remaining 107 patients, 10 already had and 6 went on to have cholecystectomy due to personal preferences. The patients who did proceed to a cholecystectomy had a mean hospital stay of 14 days (range 1–25) and 5 (83 %) patients developed post-operative complications. A total of 91 patients were managed conservatively over a mean follow-up period of 41 months (1–89). During the follow-up period 13 (14.3 %) patients re-presented with biliary symptoms, of which 2 patients presented more than once.

Conclusions: In patients aged 80 years and over, non-operative management after ERCP for CBD stones is a possible alternative with acceptable risks.

R. Jain, R. Teasdale, D. Chattopadhyay, B. Gopinath, M. Rao, European Surgery 1/2016

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