[Biliary diseases in the elderly: diagnosis and therapy].

Biliary diseases in the elderly results in two major problems: gallstone disease and malignant jaundice. Ultrasonography and direct cholegraphy via the transpapillary or transhepatic route are the appropriate diagnostic methods. "Open" or "minimal invasive" laparoscopic cholecystectomy is indicated in patients with symptomatic cholecystolithiasis requiring definitive treatment. Elderly patients will rarely be good candidates for conservative management with gallbladder stone fragmentation and/or dissolution. In patients with acute cholecystitis and gallstone ileus surgical intervention is recommended. Bile duct stones with or without gallbladder in situ are today an indication for endoscopic therapy. Most patients with malignant obstruction of the common bile duct, in whom operative resection is not advocated, may effectively be palliated by transpapillary or transhepatic stenting.