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Is complete stone removal for choledocholithiasis always necessary in extremely elderly patients?
Naoko Okuda1, Shinya Sugimoto1, Haruka Nakamura1
1Divisions of Gastroenterology Ise Red Cross Hospital Mie Japan.
JGH Open : an Open Access Journal of Gastroenterology and Hepatology
|February 15, 2020
Summary
Complete endoscopic stone removal may not be necessary for extremely elderly patients over 90. This study found no significant difference in survival rates between complete and incomplete stone removal groups in this age demographic.
Area of Science:
- Gastroenterology
- Geriatric Medicine
- Surgical Outcomes
Background:
- Increasing life expectancy highlights the need to optimize care for elderly patients.
- Endoscopic stone removal for choledocholithiasis carries potential complications.
- Limited data exists on the necessity of complete stone removal in extremely elderly individuals.
Purpose of the Study:
- To assess the safety and efficacy of complete endoscopic stone removal in patients aged 90 years and older.
- To compare complication rates, overall survival (OS), and disease-specific survival (DSS) between complete and incomplete stone removal groups.
Main Methods:
- Retrospective evaluation of 73 patients (≥90 years) who underwent endoscopic stone removal for choledocholithiasis (January 2012 - January 2017).
- Patients were categorized into complete stone removal and incomplete stone removal groups.
- Comparison of complication rates, OS, and DSS using Kaplan-Meier analysis.
Main Results:
- No significant differences in overall survival (OS) (P=0.052) or disease-specific survival (DSS) (P=0.646) were observed between the complete and incomplete stone removal groups.
- The complete stone removal group had fewer stones (median 1 vs 2, P=0.043) and smaller largest stones (median 9mm vs 14mm, P=0.001).
- Survival rates were 60% OS and 95% DSS for complete removal, versus 39% OS and 97% DSS for incomplete removal.
Conclusions:
- Complete endoscopic stone removal may not be essential for extremely elderly patients (≥90 years).
- The decision for complete stone removal should consider the potential risks and benefits in this vulnerable population.
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