Abstract
Background and aims
Although patients with cholecystocholedocholithiasis are generally referred to cholecystectomy after endoscopic sphincterotomy (ES) and common bile duct clearance, we often have a conflict whether cholecystectomy is necessary in very elderly patients with comorbid diseases. The aim of this study is to assess whether cholecystectomy in very elderly patients is justified after ES.
Patients and methods
Patients with cholecystocholedocholithiasis who underwent ES and stone extraction and were followed-up for more than 10 years were retrospectively reviewed. We divided these patients into two groups: the elderly group (equal to or more than 80 years old) and young group (less than 80 years old) and compared late biliary complications and mortality.
Results
The 10-year cumulative incidence of overall biliary complications was significantly lower in cholecystectomized patients than in patients with gallbladder in situ in the young group (7.5 vs. 21.7%, p = 0.0037), but not different in the elderly group (8.3 vs. 7.4%, p = 0.92). When each complication was evaluated separately, the rate of recurrent common bile duct stones (CBDS) was not different, but that of acute cholecystitis was significantly lower in the elderly group than in the young group (4.1 vs. 22.6%, p = 0.011).
Conclusions
In very elderly patients the incidence of acute cholecystitis is low even when the gallbladder is preserved after endoscopic treatment of CBDS, with a similar risk of CBDS recurrence. Thus, it may not be necessary to recommend cholecystectomy after ES for CBDS in very elderly patients.
Similar content being viewed by others
References
Dubois F, Icard P, Berthelot H, Levard G. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990;211:60–2.
Tanaka M, Ikeda S, Yoshimoto H, Matsumoto S. The long-term fate of the gallbladder after endoscopic sphincterotomy. Complete follow-up study of 122 patients. Am J Surg. 1987;154:505–9.
Kageoka M, Watanabe F, Maruyama Y, Nagata K, Ohata A, Noda Y, et al. Long-term prognosis of patients after endoscopic sphincterotomy for choledocholithiasis. Dig Endosc. 2009;21:170–5.
Pereira-Lima JC, Jakobs R, Winter UH, Benz C, Martin WR, Adamek HE, et al. Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms. Gastrointest Endosc. 1998;48:457–64.
Sanjay P, Yeeting S, Whigham C, Judson H, Polignano FM, Tait IS. Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP). Surg Endosc. 2008;22:1832–7.
Lee KM, Paik CN, Chung WC, Kim JD, Lee CR, Yang JM. Risk factors for cholecystectomy in patients with gallbladder stones after endoscopic clearance of common bile duct stones. Surg Endosc. 2009;23:1713–9.
Boerma D, Rauws EA, Keulemans YC, Janssen IM, Bolwerk CJ, Timmer R, et al. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Lancet. 2002;360:761–5.
Lau JY, Leow CK, Fung TM, Suen BY, Yu LM, Lai PB, et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients. Gastroenterology. 2006;130:96–103.
Schreurs WH, Vles WJ, Stuifbergen WH, Oostvogel HJ. Endoscopic management of common bile duct stones leaving the gallbladder in situ. A cohort study with long-term follow-up. Dig Surg. 2004;21:60–4. (discussion 65).
Hammarstrom LE, Holmin T, Stridbeck H. Endoscopic treatment of bile duct calculi in patients with gallbladder in situ: long-term outcome and factors. Scand J Gastroenterol. 1996;31:294–301.
Kwon SK, Lee BS, Kim NJ, Lee HY, Chae HB, Youn SJ, et al. Is cholecystectomy necessary after ERCP for bile duct stones in patients with gallbladder in situ? Korean J Intern Med. 2001;16:254–9.
Kim HO, Yun JW, Shin JH, Hwang SI, Cho YK, Son BH, et al. Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly. World J Gastroenterol. 2009;15:722–6.
Pigott JP, Williams GB. Cholecystectomy in the elderly. Am J Surg. 1988;155:408–10.
Uchiyama K, Onishi H, Tani M, Kinoshita H, Kawai M, Ueno M, et al. Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg. 2003;238:97–102.
Saharia PC, Zuidema GD, Cameron JL. Primary common duct stones. Ann Surg. 1977;185:598–604.
Bernhoft RA, Pellegrini CA, Motson RW, Way LW. Composition and morphologic and clinical features of common duct stones. Am J Surg. 1984;148:77–85.
Trotman BW, Soloway RD. Pigment vs cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis. 1975;20:735–40.
Iso H, Date C, Noda H, Yoshimura T, Tamakoshi A. Frequency of food intake and estimated nutrient intake among men and women: the JACC study. J Epidemiol. 2005;15(Suppl 1):S24–42.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yasui, T., Takahata, S., Kono, H. et al. Is cholecystectomy necessary after endoscopic treatment of bile duct stones in patients older than 80 years of age?. J Gastroenterol 47, 65–70 (2012). https://doi.org/10.1007/s00535-011-0461-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-011-0461-3