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[Choledocholithiasis in non-cholecystectomized patients: endoscopic sphincterotomy and afterwards ...
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Endoscopic sphincterotomy is effective for elderly patients with choledocholithiasis and an in-situ gallbladder. Routine cholecystectomy is often unnecessary, as most patients remain asymptomatic without complications.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Biliary tract disease
Background:
- Choledocholithiasis with an intact gallbladder is a common indication for endoscopic sphincterotomy.
- The necessity of subsequent cholecystectomy in these patients remains a clinical challenge.
Purpose of the Study:
- To evaluate the long-term outcomes of endoscopic sphincterotomy in elderly patients with choledocholithiasis and an in-situ gallbladder.
- To determine the necessity of routine cholecystectomy following endoscopic sphincterotomy in this patient cohort.
Main Methods:
- Retrospective follow-up study of 39 patients (mean age 80.1 years) who underwent successful endoscopic sphincterotomy for choledocholithiasis with gallbladder in situ.
- Average follow-up duration of 41.5 months.
Main Results:
- Only 3% of patients developed acute cholecystitis requiring cholecystectomy.
- 91% of patients remained asymptomatic, with 6% experiencing mild upper quadrant pain.
- 30.3% of patients died from non-biliary causes during the follow-up period.
Conclusions:
- Endoscopic sphincterotomy is an effective treatment for choledocholithiasis in elderly or high-risk patients with an in-situ gallbladder.
- Routine prophylactic cholecystectomy is not generally indicated in these patients after successful endoscopic sphincterotomy.
Abstract:
Choledocholithiasis in patients with a gallbladder "in situ" is presently one of the most frequent indications of endoscopic sphincterotomy. The crucial problem of these patients is whether or not they require eventual cholecystectomy to avoid the risks of potential complications of cholelithiasis. Of the 39 patients (mean age 80.1 +/- 8.2 years) with choledocholithiasis and gallbladder "in situ" released from this hospital from October 1979 to December 1985 after a successful endoscopic sphincterotomy (expulsion, spontaneous or not, of gallstones), 33 (84.6%) have been followed-up for an average of 41.5 +/- 20.8 months (7-92 range). During this time only one patient (3%) developed acute cholecystitis that required cholecystectomy, and two (6%) denoted mild pains in the right upper quadrant, while the other 30 (91%) remained asymptomatic. Over these years 10 patients (30.3%) died from nonbiliary causes. In conclusion, in elderly or high surgical risk patients who present choledocholithiasis and gallbladder "in situ", endoscopic sphincterotomy is effective. Later cholecystectomy to prevent the complications of cholelithiasis would not be justified as a routine measure in most of these patients.