Cholecystectomy after ERCP in the over 80’s: Adding insult to injury?

Rebecca L Teasdale, Miss, Mukhtar Ahmad, Mr, Bussa R Gopinath, Mr

North Tees and Hartlepool NHS Trust

Aim
To investigate the outcome of patients, over the age of 80, found to have common bile duct (CBD) stones at endoscopic retrograde cholangio-pancreatography (ERCP).

Methods
Retrospective analysis of endoscopy database and case notes was carried out on all patients 80 years and over who underwent ERCP between February 2007 and December 2008. Those found to have CBD stones were included. Cases were followed up to present.

Results
68 patients were evaluated. Mean age was 85 (range 80-94). 50 were female, 18 Male. 3 already had and 5 went on to have a cholecystectomy. The patients who did proceed to a cholecystectomy had a mean hospital stay of 14 days (range 3-25) and all developed post-operative complications. 3 were carried out laparoscopically and 2 were converted to open. 2 patients went into acute renal failure post-op (both open cholecystectomy), 2 were treated for a lower respiratory tract infection and 1 for a urinary tract infection. 1 patient had an intra-abdominal collection, which was treated conservatively. 1 represented with biliary stricture and sepsis. 60 did not have surgery following their ERCP. 3 patients died during the same admission from cholangitis and the remaining patients were deemed unfit or declined surgery. 11 (18%) patients re-presented over the follow-up period. 2 patients had biliary colic, 2 cholecystitis, 2 cholangitis, 4 with CBD stones and 1 with a CBD stricture. 2 of these patients presented more than once and 1 died from biliary sepsis. 2 of these patients did not have a sphincterotomy performed, due to abnormal clotting. 9 patients died within the follow-up period from non-gallstone related disease.

Conclusions
Surgery in the over 80’s is associated with greater length of hospital stay and incidence of post-operative complications. In patients who do not have symptoms of gallstone disease non-operative management of CBD stones post ERCP + sphincterotomy is a safe alternative.


Session: Podium Presentation

Program Number: S039

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