Cholecystectomy after Sphincterotomy for Preventing Recurrence in Elderly Patients with Acute Cholangitis

Abstract

Background: laparoscopic cholecystectomy (LC) following endoscopic sphincterotomy (ES) in elderly patients with concomitant gallbladder stones remains a matter of debate. Methods: We retrospectively collected data from 84 patients aged >65 years who had common bile duct stones (CBDS) with cholangitis and had undergone successful ES between July 2007 and October 2010. We divided the patients into 2 groups: the cholecystectomy and wait-and-see groups. We also compared two age groups, namely, the young-old (65–74 years) and old (>75 years) groups. The endpoint was the presence of symptoms indicating recurrence of biliary events. Results: The recurrence rate was lower in patients who underwent subsequent cholecystectomy than in patients in the wait-and-see group. However, among the patients in the old group, the time to recurrence did not significantly differ between the cholecystectomy and wait-and-see groups. Univariate analysis showed that the presence of a juxtapapillary diverticulum (JPD) was an independent factor predicting recurrence. Conclusion: Cholecystectomy after ES is recommended for patients with CBDS aged <75 years. JPD increases the recurrence risk in patients who do not undergo subsequent cholecystectomy.

Keywords

• cholangitis
• cholecystitis
• cholecystectomy
• elderly
• endoscopic sphincterotomy