Surgery in elderly patients with acute cholecystitis is quite a high-risk procedure.
There was a recent finding that activated pancreatic enzyme is present in sterile bile from the acutely inflamed gallbladder.
This suggests that obstruction at the level of the common channel is a possible precipitating factor.
Dr Vracko and colleagues from Sweden hypothesized that an initial endoscopic sphincterotomy in acute cholecystitis might improve the clinical course.
The research team evaluated a prospective unselected series of 105 patients over 65 years of age suffering from acute cholecystitis.
|Iatrogenic complications after endoscopic sphincterotomy occurred in 3 patients|
The patients were initially treated on a random basis with either conservative methods or endoscopic sphincterotomy.
Within 72 hours after the onset of symptoms, all 52 patients in the endoscopic sphincterotomy group were managed by endoscopic retrograde cholangiopancreatography (ERCP).
ERCP was combined with endoscopic sphincterotomy in 50 cases.
The researcher's main study parameter was the need for emergency cholecystectomy within the first week after admission.
The researchers found that biliary sepsis requiring emergency surgery occurred in 15 patients in the conservatively treated group.
In contrast, none of the 52 patients in the endoscopic sphincterotomy group required emergency surgery.
The team noted that iatrogenic complications after endoscopic sphincterotomy occurred in 3 patients.
Of these, 1 required surgery, while 2 were managed by conservative means.
The clinical course improved, avoiding the need for emergency cholecystectomy and other interventions more in patients of the endoscopic sphincterotomy group.
Dr Vracko's team concluded, “The clinical course after endoscopic sphincterotomy improved in the majority of elderly patients suffering from acute cholecystitis.”
“This suggests that early relief of obstruction at the level of the common channel reduces the risk of developing biliary sepsis.”
“The majority of these patients can undergo surgery electively or can receive further conservative treatment.”