Endoscopic treatment of bile duct stones in elderly people

Consider cholecystectomy unless patient is unfit

Although the standard treatment of gall bladder and bile duct stones has been surgical, postoperative morbidity and mortality increase with age and concomitant disease.1 Peroral endoscopic techniques provide an effective alternative for removing bile duct stones by endoscopic sphincterotomy and stone extraction and may be safer than surgery in elderly people and other high risk groups as the associated morbidity and mortality are unchanged regardless of age.2 As endoscopic management of bile duct stones and leaving the gall bladder in situ could be definitive treatment in these patients, there is a tendency to adopt a wait and see strategy even in those who may be fit for surgery.3 Several recent series have, however, suggested that morbidity and mortality after surgical bile duct exploration have decreased,4 and two recent prospective randomised studies have questioned the rationale for leaving the gall bladder in situ after endoscopic sphincterotomy. 5 6 Indeed, the published evidence suggests an individualised approach to the management and outcomes of bile duct and gall bladder stones in elderly and high risk patients.

Prospective randomised studies comparing …