The challenge of cholecystectomy after successful choledocholithiasis extraction in elderly patients with...

Traditionally, cholecystectomy is recommended for patients who have had choledochal stone extraction with endoscopic retrograde cholangiopancreatography (ERCP) at the same session or as soon as possible. However, it is thought that ERCP reduces the need for cholecystectomy, especially in elderly patients. In this study, the prognosis of elderly patients who had biliary tract stones removed with ERCP was examined.

A total of 2251 ERCP procedures performed in our clinic between January 2014 and January 2016 were retrospectively reviewed. The demographic data and ERCP procedure findings of a total of 494 patients who had choledochal stone treatment with ERCP were recorded. The patients were then contacted by phone to evaluate their cholecystectomy status and biliary complications that developed during follow-up. A total of 182 patients could not be reached by phone and were excluded from the study. The patients were divided into two groups according to the age limit of 70, and their characteristics were compared.

The study included 90 patients under the age of 70 and 110 patients aged 70 and over who did not undergo early cholecystectomy. A total of 63 patients died during the follow-up period, with the majority being in the over-70 age group. Comorbidities were associated with increased mortality. Gallbladder-related disease was not among the causes of death.

Biliary stone extraction with ERCP can be considered as an alternative to cholecystectomy in elderly patients, especially in those with comorbidities, high risk of stone recurrence, and surgical risk.