Comparative Outcomes of Endoscopic Treatment for Symptomatic and Asymptomatic Common Bile Duct Stones in the Elderly:...

Various guidelines recommend endoscopic stone removal for asymptomatic common bile duct stones (CBDS); however, previous studies have indicated that asymptomatic CBDS is associated with a higher incidence of post-ERCP pancreatitis (PEP). Our study aimed to compare the clinical outcomes of ERCP between elderly patients with asymptomatic and symptomatic CBDS.

Elderly patients with CBDS were divided into two groups: A (asymptomatic CBDS) and S (symptomatic CBDS). Propensity score matching was performed to reduce possible bias in the baseline characteristics between the two groups, yielding 221 matched patients. Primary outcomes included early adverse events (AEs) during ERCP, while secondary outcomes included technical success rate and late AEs.

Regarding ERCP-related early AEs, the incidence of PEP was 6.3% in group A and 4.5% in group S, with no significant difference between the groups. The technical success rates were 87.8% and 84.6% in groups A and S, respectively, with no significant difference. The most common late AE was the recurrence of CBDS (11.3% in group A versus 18.6% in group S [p = 0.04]); Kaplan-Meier analysis also revealed a tendency toward a higher cumulative incidence in group S.

Endoscopic transpapillary stone extraction in asymptomatic elderly patients may be beneficial.