Expectant treatment or cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years old?

Abstract

Expectant treatment can be recommended in this group of patients. Those who do present with further biliary symptoms do so soon after ERCP. Therefore, we recommend follow-up for 12 months after ERCP, prior to discharge.

Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk?

“…These data are confirmed by a review of the English language literature (Table 5) [1,2,4,8,9,15,22,30,31,33], which reports an overall mortality rate of 2% for LC in the very elderly, approaching 10% in some series [15,30,33]. In view of this consideration, a regular follow-up evaluation of very elderly patients after ES has been suggested [13,23], with cholecystectomy performed only when strictly needed.…”

“…On the other hand, in a series of 81 consecutive patients older than 80 years treated with an expectant policy after ES, Pring et al [23] described a very low readmittance rate attributable to further biliary symptoms (11%), and thus recommended a routine wait-andsee policy for this class of patients. However, although Pring and colleagues actually avoided almost 90% of unnecessary cholecystectomies, all the readmitted patients presented with very serious conditions, leading to death in three cases (biliary-related mortality of 3.7%).…”

“…Whereas findings show ES to be very effective and safe for very elderly patients [19,28], LC is followed by worse results [2,4,9,31] in the elderly than in the general population. Therefore, a routine ''wait-and-see'' attitude after an ES for cholecystocholedocholithiasis for patients older than 80 years has been suggested recently [13,23].Since the early 1990s, ES and routine, early-scheduled, elective LC have been carried out as a standard protocol [26] in one center for all patients with CBD stones, regardless of age. Considering that reports as to the long-term results of the sequential treatment (LC Preliminary results presented at the 13th International…”

“…Whereas findings show ES to be very effective and safe for very elderly patients [19,28], LC is followed by worse results [2,4,9,31] in the elderly than in the general population. Therefore, a routine ''wait-and-see'' attitude after an ES for cholecystocholedocholithiasis for patients older than 80 years has been suggested recently [13,23].…”

Expectant treatment of cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years of age

“…We found the article by Pring and co-workers [8] of great interest. In the recent literature, it has been debated whether cholecystectomy after endoscopic sphincterotomy (ES) is indicated on a routine basis, on selected patients or not at all, considering a wait-and-see policy preferable.…”