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Web End = Dig Dis Sci (2015) 60:17701777 DOI 10.1007/s10620-014-3497-4
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Web End = Gallstone-Related Disease in the Elderly: Is There Room for Improvement?
Francisco Javier Garca-Alonso Mara de Lucas Gallego
Daniel Bonillo Cambrodn Alicia Algaba Gema de la Poza
Rosa Mara Martn-Mateos Fernando Bermejo
Received: 11 September 2014 / Accepted: 18 December 2014 / Published online: 11 January 2015 Springer Science+Business Media New York 2015
AbstractBackground and Aim Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a rst acute biliary complication. In the aging, these recommendations are irregularly followed.
Methods We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were dened according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identied.
Results A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 2125 %. Overall mortality rate was 5.4 %:10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a
1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures,42.3 % than in cholecystectomy patients, 9.9 % (p \ 0.001) and than in ERCP patients, 19.4 % (p = 0.01).
Conclusions Cholecystectomy should be recommended to elderly patients after a rst acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.
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