Reappraisal of safety of endoscopic sphincterotomy for common bile duct stones in the elderly

: Endoscopic sphincterotomy is the method of choice for elderly patients with common bile duct stones, even though these patients are poor operative risks. We undertook this study to analyze the operative risk factors for this age group. : We compared specific problems of 182 patients aged 80 years or older and 921 younger patients who underwent endoscopic sphincterotomy for common bile duct stones. : Despite a higher frequency of periampullary diverticula in the elderly than in the younger patients (54% versus 36%, P<0.001), the success rates of sphincterotomy were not different. The elderly patients required lithotripsy more often than did the younger ones (15% versus 4%, P<0.001), and the necessity of stenting or nasobiliary drainage was greater in this group (9%) than in the younger group (5%, P<0.05). This difference in the tactics between the older and younger groups was due to the greater number and size of stones, longer period of time for complete clearance of the common bile duct (13.5 versus 6.0 days, P<0.01), and a greater percentage of patients with operative risks (55% versus 36%, P<0.001). The elderly also had significantly greater overall morbidity compared with the younger patients (13% versus 7%, P<0.005), frequency of acute cholangitis (8% versus 2%, P<0.001), and mortality (1% versus 0%). : These results suggest that frequent stenting or nasobiliary drainage to prevent cholangitis or prompt stone removal by lithotripsy would be necessary in this group of patients.