Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older

Background: Little information is available on the outcomes of endoscopic sphincterotomy for choledocholithiasis in patients of advanced age (greater than or equal to 90 years). Methods: Endoscopic sphincterotomy was performed for choledocholithiasis in 22 patients aged 90 years or more (group A) and 381 aged 70 to 89 years (group B). Clinical features and early outcomes of endoscopic sphincterotomy were compared between the two groups. In group A, longterm results for a mean follow-up period of 33 months were assessed. Results: Group A patients had a higher incidence of symptoms, acute cholangitis and concomitant diseases, as well as larger and more numerous gallstones than did group B patients. Endoscopic sphincterotomy was technically successful in 100% of group A patients and 98% of group B patients. The rate of early complications was low in both groups: 5% in group A and 7% in group B. No deaths related to endoscopic retrograde cholangiopancreatography occurred in group A patients. Complete stone clearance was achieved in 86% of group A patients and 95% of group B patients. Group A required an emergency procedure, general anesthesia, multiple sessions, mechanical lithotripsy, and permanent biliary stent placement more frequently than group B. Late complications occurred in 5% of group A patients. Conclusion: Endoscopic sphincterotomy is safe and effective for the treatment of choledocholithiasis in patients 90 years of age or older. Biliary stent placement is a reasonable alternative treatment when stones prove to be difficult to extract.