CHICAGO — Cholecystectomy should be performed after endoscopic removal of bile duct stones in patients older than 60 years who also have gallstones, James Lau, M.D., said at the annual Digestive Disease Week.
Surgical removal of the gallbladder, performed either traditionally or endoscopically, significantly reduces recurrent biliary events, compared with those that occur when the gallbladder is left in situ, Dr. Lau reported.
“There is a perceived high morbidity with cholecystectomy in patients older than 60,” said Dr. Lau of Prince of Wales Hospital and Chinese University of Hong Kong. However, he and his associates found that this was not the case.
The researchers randomly assigned 178 patients older than 60 who had concomitant gallstones (pigment stones) to either cholecystectomy or expectant management following endoscopic sphincterotomy and clearance of bile duct stones. Of those, 82 patients elected to have cholecystectomy, and 88 patients kept their gallbladder and were managed with watchful waiting.
During a median follow-up of 66 months, six patients (7.3%) in the cholecystectomy group returned for treatment of biliary events, primarily cholangitis, Dr. Lau reported. In the observation group, 21 patients (24%) experienced recurrent events, including bile duct stones and cholangitis, acute cholecystitis, or biliary colic. Additionally, more persons in the observation group died than did those who underwent cholecystectomy (19 vs. 11), he said.
In recommending cholecystectomy in this older patient population, Dr. Lau cautioned that the conversion rate from laparoscopic to open cholecystectomy is expected to be high. Conversion to open surgery was needed in 16 (20%) of the 82 patients.
Cholecystectomy benefited patients who had bile duct stones removed and also had gallstones, shown here by sonography. ©Elsevier 2002. Sleisenger & Fordtran's Gastrointestinal and Liver Disease 7E