Cholecystectomy is often recommended after treatment for common bile duct stones. However, especially in the elderly, it is difficult to decide whether to recommend cholecystectomy. A study from Japan showed that the presence or absence of cholecystectomy does not affect biliary tract problems or mortality in patients ≥80 years old. Follow-up may be appropriate, without surgery.
Patients with choledocholithiasis have been shown to have a high incidence of acute cholecystitis after endoscopically treating bile duct stones. This study assessed the necessity of cholecystectomy for gallstones after treatment of choledocholithiasis in elderly patients over 80 years of age. The rate of biliary troubles and mortality according to the presence or absence of cholecystectomy were studied as well.
Of the 314 patients who underwent endoscopic retrograde cholangiopancreatography for common bile duct stones in a Japanese hospital over 5 years (2011-2016), 197 patients had gallstones. The current retrospective analysis compared 106 cases aged ≤79 years (young group) with 91 cases aged ≥80 years (elderly group). The patient background was different between both groups in terms of sex ratio and mean common bile duct diameter. The mean observation period was not different in both groups.
Cholecystectomy was performed in 51% of the young group and 9% of the elderly group. The rate of surgery was significantly lower in the elderly group. Postoperative biliary troubles occurred in 18% of the young group and 30% of the elderly group. Cholecystectomy significantly reduced the risk of biliary problems in the young group, but there was no significant difference in mortality. There were no significant differences in biliary trouble and death in the elderly group.
This study showed that the presence or absence of cholecystectomy does not affect biliary tract problems or death in elderly people over 80 years old. Follow-up may be appropriate without surgery. Further studies with larger sample sizes are needed.
1. Kodama R. Study of the necessity of cholecystectomy after treatment of choledocholithiasis for elderly patients. UEG Week Virtual Symposium 2020, abstract OP187.