title: Is cholecystectomy necessary after endoscopic treatment of bile duct stones in patients older than 80 years of age?
abstract: OBJECTIVE
  Although patients with cholecystocholedocholithiasis are generally referred to cholecystectomy after endoscopic sphincterotomy (ES) and common bile duct clearance, we often have a conflict whether cholecystectomy is necessary in very elderly patients with comorbid diseases. The aim of this study is to assess whether cholecystectomy in very elderly patients is justified after ES.
  
  
  METHODS
  Patients with cholecystocholedocholithiasis who underwent ES and stone extraction and were followed-up for more than 10 years were retrospectively reviewed. We divided these patients into two groups: the elderly group (equal to or more than 80 years old) and young group (less than 80 years old) and compared late biliary complications and mortality.
  
  
  RESULTS
  The 10-year cumulative incidence of overall biliary complications was significantly lower in cholecystectomized patients than in patients with gallbladder in situ in the young group (7.5 vs. 21.7%, p = 0.0037), but not different in the elderly group (8.3 vs. 7.4%, p = 0.92). When each complication was evaluated separately, the rate of recurrent common bile duct stones (CBDS) was not different, but that of acute cholecystitis was significantly lower in the elderly group than in the young group (4.1 vs. 22.6%, p = 0.011).
  
  
  CONCLUSIONS
  In very elderly patients the incidence of acute cholecystitis is low even when the gallbladder is preserved after endoscopic treatment of CBDS, with a similar risk of CBDS recurrence. Thus, it may not be necessary to recommend cholecystectomy after ES for CBDS in very elderly patients.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-8582, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Yasui
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kono
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nagayoshi
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Mori
authors.forename: Kosuke
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sadakari
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D002764:Cholecystitis / Q000453:epidemiology; D041761:Cholecystolithiasis / Q000601:surgery*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*