Role of endoscopic sphincterotomy alone in patients with choledocholithiasis and cholelithiasis.

OBJECTIVE

To study the long-term effects of endoscopic sphincterotomy alone in elderly patients with choledocholithiasis and cholelithiasis.

DESIGN

A chart review.

SETTING

A university-affiliated hospital.

PATIENTS: Twenty-one patients over 60 years of age, who presented with cholecystitis, jaundice or cholangitis. The follow-up ranged from 1 to 5 years (mean 3.51 years).

INTERVENTION: Endoscopic sphincterotomy.

MAIN OUTCOME MEASURES: The occurrence of postsphincterotomy pancreatitis, cholangitis and cholecystitis.

RESULTS

In the early postsphincterotomy period, 3 of the 21 patients had pancreatitis, which was treated conservatively. One patient had cholangitis. In this patient the initial sphincterotomy did not clear the common bile duct of all stones, but a repeat procedure was successful and the cholangitis resolved. One patient had mild cholecystitis that responded to conservative therapy. In the long term, 9 of the 21 patients had cholecystitis. This was treated conservatively in six patients, but three required cholecystectomy. One patient had choledocholithiasis requiring exploration of the common bile duct.

CONCLUSIONS

In elderly debilitated patients with cholelithiasis and choledocholithiasis, endoscopic sphincterotomy alone may be adequate therapy. However, patients presenting with cholangitis and cholelithiasis may eventually require cholecystectomy.