[Natural history and URSO dissolution therapy of gallbladder stones in the elderly]

To determine how to treat silent gallstones in the elderly, 1771 autopsied cases 65 years of age or older were studied retrospectively, and 121 cases with asymptomatic gallbladder stones were followed for over 3 years. Of these, 47 cases treated with ursodeoxycholic acid (UDC) for over 3 years were investigated to determine the efficacy of UDC therapy. In the autopsied cases, the incidence of gallbladder stones was 16%, and increased with age. The ratio of males to females was 1:1.2. Only 3.2% of people with silent gallstones developed symptoms. Autopsy studies showed that the majority of people with gallstones died of unrelated causes such as benign respiratory and circulatory diseases. Only 1.8% of patients with gallstones died of acute cholecystitis or gallbladder carcinoma. UDC treatment was effective in 55.9% of patients with radiolucent stones. The percentage of patients requiring surgery due to becoming symptomatic was much lower (6.4%) in UDC-treated patients. The visualization of the gallbladder on cholecystogram improved in cases treated with UDC. These results indicate that elderly patients with silent gallstones generally develop neither symptoms nor carcinoma. Therefore, follow-up management by ultrasonography and cholecystography can be allowed. We also emphasized that a satisfactory response was obtained with long term UDC therapy.