Stenting or surgery for treatment of irretrievable common bile duct calculi in elderly patients?
BACKGROUND
The value of endoprostheses for long-term management of bile duct stones has not been formally established. We retrospectively compared the results of this method versus surgical approach in elderly patients (>70 years) with endoscopically irretrievable bile duct stones.


METHODS
From January 1990 to September 1998, 68 patients over 70 years old underwent endoscopic biliary stenting (group A: 31 patients) or surgery (group B: 37 patients) for endoscopically irretrievable bile duct stones. The groups were similar with regard to gender, age, clinical presentation, ASA score, and number and size of the stones.


RESULTS
Successful biliary drainage was achieved in 31 of 31 patients of group A and 37 of 37 patients of group B. Early complications occurred in 12.9% of group A versus 29.7% of group B (P <0.005) and early mortality was 0% in group A versus 2.7% of group B (P = NS). Over the long-term follow-up, late complications occurred in 35.5% of group A versus 8.1 % of group B (P <0.001). Three cases of biliary-related death occurred in group A versus 0 in group B (9.6% versus 0%: P <0.005).


CONCLUSIONS
For immediate bile duct drainage endoprostheses proved a safe and effective alternative to surgery in elderly patients with endoscopically irretrievable bile duct stones. Because of the risk of subsequent complications, their use as a definitive treatment should be restricted to highly selected cases.
De Palma
G D
GD
Department of Surgery, University of Naples Federico II, School of Medicine, Italy.
Catanzano
C
C
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome