Stenting or surgery for treatment of irretrievable common bile duct calculi in elderly patients?

BACKGROUND: The value of endoprostheses for long-term management of bile du ct stones has not been formally established. We retrospectively compared th e results of this method versus surgical approach in elderly patients (>70 years) with endoscopically irretrievable bile duct stones. METHODS: From January 1990 to September 1998, 68 patients over 70 years old underwent endoscopic biliary stenting (group A: 31 patients) or surgery (g roup B: 37 patients) for endoscopically irretrievable bile duct stones. The groups were similar with regard to gender, age, clinical presentation, ASA score, and number and size of the stones. RESULTS: Successful biliary drainage was achieved in 31 of 31 patients of g roup A and 37 of 37 patients of group B, Early complications occurred in 12 .9% of group A versus 29.7% of group B (P <0.005) and early mortality was 0 % in group A versus 2.7% of group B (P = NS), Over the long-term follow-up, late complications occurred in 35.5% of group A versus 8.1% of group B (P <0.001). Three cases of biliary-related death occurred in group A versus 0 in group B (9.6% versus 0%: P <0.005). CONCLUSIONS: For immediate bile duct drainage endoprostheses proved a safe and effective alternative to surgery in elderly patients with endoscopicall y irretrievable bile duct stones. Because of the risk of subsequent complic ations, their use as a definitive treatment should be restricted to highly selected cases.