Delayed Cholecystectomy After ERCP in Geriatric Patients: Balancing Surgical Risk and Recurrence Prevention - A Retrospective Study.

BACKGROUND

Laparoscopic cholecystectomy (LC) is commonly recommended following endoscopic retrograde cholangiopancreatography (ERCP) to reduce the risk of recurrent biliary events (RBE). However, in geriatric patients, this strategy remains controversial due to increased surgical risk, comorbid conditions, and decreased physiologic reserve. This study aimed to evaluate the outcomes of delayed LC in geriatric patients after ERCP for bile duct stone removal, emphasizing the role of individualized treatment planning.

METHODS

We retrospectively reviewed medical records of patients aged ≥75 years who underwent ERCP at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, from January 2018 to December 2023. Patients were grouped based on whether they underwent delayed LC (>6 weeks post-ERCP). Clinical characteristics, RBE incidence, and mortality were analyzed. Multivariate logistic regression was used to identify predictors of RBE.

RESULTS

Of 152 geriatric patients (mean age 82.3 years; 48% male), 53.3% had an ASA score ≥3, and the mean Charlson Comorbidity Index was 4.8. Delayed LC was performed in 34.2% of patients. RBE occurred in 8.6% overall, with a median onset of 390 days. The incidence of RBE was significantly lower in patients who underwent delayed LC compared with those managed without surgery (3.8% vs 11.0%, = 0.035). RBE-related mortality was 0.7%, and surgery-related mortality was 1.9%. Multivariate analysis identified age ≥82 years as the only independent predictor of RBE (OR 5.7, 95% CI 2.15-25.05, = 0.014).

CONCLUSION

Subsequent LC should be considered in geriatric patients to reduce the risk of RBE after ERCP. However, given the low rates of RBE and mortality observed, a wait-and-see strategy may be a reasonable alternative in selected high-risk patients. Treatment decisions should be individualized, considering each patient's comorbidities, surgical risk, and overall health status.