Duodenoscopic sphincterotomy for removal of bile duct stones in patients with gallbladders.

Duodenoscopic sphincterotomy was attempted in 71 elderly patients with gallbladders who presented with acute symptoms caused by common bile duct stones. Sphincterotomy was possible in all but one patient, and duct clearance was achieved in 61 (86%); failures were usually due to the size of the stones. Two patients required blood transfusions for immediate bleeding, and two underwent cholecystectomy for acute cholecystitis developing within 7 days of sphincterotomy. One patient with a retained stone was judged to be unfit for surgery and died 6 weeks after sphincterotomy. Eleven patients had elective cholecystectomy. Forty-eight patients (mean age 75 years) were discharged with their gallbladders in place; clinical follow-up (mean 19 months) had been possible in 44. None have suffered cholangitis or jaundice, and only five have so far needed cholecystectomy for recurrent biliary pains. Duodenoscopic sphincterotomy is recommended for acutely ill patients with symptoms caused by duct stones, even patients with gallbladders. Longer follow-up is required to judge the indications for subsequent cholecystectomy, but present evidence suggests that it is reasonable to postpone cholecystectomy indefinitely for many elderly and frail patients.