Gallstone-Related Disease in the Elderly: Is There Room for Improvement?

Abstract

Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.

Outcome of elderly patients after acute biliary pancreatitis

“…Despite multiple comorbidities and higher Charlson index in the elderly group at admission, the present study suggests that age did affect neither mortality nor severity of acute biliary pancreatitis. These results are supported by data from previous studies showing that only 6% of patients older than 65 years developed severe acute pancreatitis (12), while others found no link between age and the risk of mortality from pancreatitis (2). There was no significant difference in the radiological severity between elderly and younger patients as assessed by both CTSI and modified CTSI.…”

“…Of note, more ERCP were performed in elderly during their hospital stay due to higher rate of obstructive cholangitis. According to a recent study including patients older than 65 years with acute biliary pancreatitis and acute cholangitis, 25% of elderly patients presented relapsed biliary complications after discharge (12). According to a previous study where ERCP in older patients with no cholecystectomy reduced the risk of developing further episode of biliary pancreatitis, ERCP with sphincterotomy should be considered when cholecystectomy is postponed or contra-indicated following an episode of biliary pancreatitis in elderly patients (18).…”

Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90)

“…This leads to increased morbidity, mortality, and cost. 6 Those who undergo surgery have a higher likelihood of undergoing open procedures than do younger patients. 5 Despite the reluctance of some surgeons to perform cholecystectomy in elderly patients, 5 cholecystectomy remains the most common general surgery procedure in the elderly.…”

Evaluation of endoscopic retrograde cholangiopancreatography success and complications according to age

“…Mortalite oranları önceki çalışmalarda %0-1.6 arasında bildirilmiştir (12,13,21 şiddeti olarak belirlemiş olup, yaş ile mortalite arasında ilişki saptamamışlardır (16). Garcia ve arkadaşları, yaşlı hastalarda antikoagülan kullanımının daha sık olması nedeni ile ERCP ilişkili kanamaların bu hasta grubunda daha sık olduğunu raporlamışlardır (33). Kanama komplikasyonunu genç ve yaşlılarda benzer bulan çalışmalar da mevcuttur (12,20,34).…”