Is elective cholecystectomy effective in geriatric patients to prevent new biliopancreatic events following endoscopic retrograde cholangiopancreatography for benign biliopancreatic pathology?

Background: Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ES) is the preferred technique for the management of benign biliary tract pathology. The initial ES performance can lead to long-term complications due to duodenal reflux into the biliary tract. In patients with cholelithiasis, elective cholecystectomy following ERCP is performed to prevent new biliary events and acute cholecystitis. There is no consensus on the indication for cholecystectomy in all cases in elderly patients. The aim of this study is to determine whether cholecystectomy is effective in preventing medium- to long-term biliopancreatic complications in elderly patients who have undergone ERCP-ES for benign conditions. Methods: This is a retrospective, observational, and comparative study that included 164 patients aged over 80 years who underwent ERCP-ES. They were divided into two groups: Group A, 89 patients who had undergone cholecystectomy before ERCP, and Group B, 75 patients without previous cholecystectomy. Epidemiological, clinical, and procedure-related variables were collected. Complications were analyzed 6 months after ERCP-ES with an average follow-up period of 82 months. The Mann-Whitney U test was applied for an independent group comparison. Cox logistic regression was used to identify a model explaining the cause-effect relationships between biliary stone recurrence, benign complications, and predictor variables. Additionally, a Kaplan-Meier survival model was employed to predict survival times in patients with choledocholithiasis and cholangitis and for repeat ERCP. Results: After ERCP, were registered a total of 22 cases of recurrent choledocholithiasis (13.41%), 8 of acute cholangitis (4.9%), 10 of acute cholecystitis (13.33%), and 1 of acute pancreatitis (0.69%). When comparing both groups, in Group A repeat ERCPs were performed in 28 patients (31.46%), as opposed to 7 patients (9.33%) in Group B, with P=0.001. There were more cases of recurrent choledocholithiasis in Group A, with 20 cases (22.47%) compared to 2 cases (2.67%) in Group B, with P=0.008. The incidence of ascending cholangitis was higher in group A (7.87% vs. 1.33%, P=0.03). Conclusions: In patients over 80 years old, laparoscopic cholecystectomy performed before ERCP-ES prevents the occurrence of subsequent episodes of acute cholecystitis but is associated with a higher incidence of post-ERCP choledocholithiasis and acute cholangitis.