Skip to main content
Springer Nature Link
Log in

Cholangitis and Choledocholithiasis

  • Chapter
  • First Online:
Emergency laparoscopic surgery in the elderly and frail patient

  • 581 Accesses

Abstract

The prevalence of cholangitis and choledocholithiasis increases with age in all populations. Age-related changes have relevant implications in the diagnosis and management of these conditions. In this chapter, we examine the peculiarities of choledocholithiasis and acute cholangitis in the elderly. As for most acute abdominal conditions, the risk of erroneous or delayed diagnosis is high in aged patients, due to their clinical characteristics and age-related changes in the physiological responses to sepsis and inflammation. The higher risk that age and frailty imply stresses the importance of less invasive techniques for the clearance of the common bile duct obstruction. We examine the literature’s best evidence about the management of these conditions in the older adults. We also analyze the role of minimally invasive surgery in the treatment of the clinical conditions of the frailer and older patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20:981–96.

    Article  Google Scholar 

  2. Nassar Y, Richter S. Management of complicated gallstones in the elderly: comparing surgical and non-surgical treatment options. Gastroenterol Rep. 2019;7:205–11.

    Article  Google Scholar 

  3. Isayama H, Yasuda I, Tan D. Current strategies for endoscopic management of acute cholangitis. Dig Endosc. 2017;29(Suppl 2):70–7.

    Article  Google Scholar 

  4. Agrusa A, Romano G, Frazzetta G, et al. Role and outcomes of laparoscopic cholecystectomy in the elderly. Int J Surg. 2014;12(Suppl 2):S37–9.

    Article  Google Scholar 

  5. Agarwal N, Sharma BC, Sarin SK. Endoscopic management of acute cholangitis in elderly patients. World J Gastroenterol. 2006;12:6551–5.

    Article  Google Scholar 

  6. Khashab MA, Tariq A, Tariq U, et al. Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol. 2012;10:1157–61.

    Article  Google Scholar 

  7. Collins C, Maguire D, Ireland A, et al. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004;239:28–33.

    Article  Google Scholar 

  8. Laurell H, Hansson L-E, Gunnarsson U. Acute abdominal pain among elderly patients. Gerontology. 2006;52(6):339–44.

    Article  CAS  Google Scholar 

  9. Hu KC, Wang HY, Chang WH, et al. Clinical presentations of patients from different age cohorts with biliary tract stone diseases. J Gastroenterol Hepatol. 2014;29:1614–9.

    Article  Google Scholar 

  10. Hu K-C, Chu C-H, Wang H-Y, et al. How does aging affect presentation and Management of Biliary Stones? J Am Geriatr Soc. 2016;64(11):2330–5. https://doi.org/10.1111/jgs.14481.

    Article  PubMed  Google Scholar 

  11. ASGE Standards of Practice Committee, Maple JT, Ikenberry SO, Anderson MA, et al. The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc. 2011;74:731–44.

    Article  Google Scholar 

  12. Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019;51:472–91.

    Article  Google Scholar 

  13. Iida T, Kaneto H, Wagatsuma K, et al. Efficacy and safety of endoscopic procedures for common bile duct stones in patients aged 85 years or older: a retrospective study. PLoS One. 2018;13(1):e0190665. https://doi.org/10.1371/journal.pone.0190665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Saito H, Koga T, Sakaguchi M, et al. Safety and efficacy of endoscopic removal of common bile duct stones in elderly patients ≥90 years of age. Intern Med. 2019;58(15):2125–32. https://doi.org/10.2169/internalmedicine.2546-18.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Narula VK, Fung EC, Overby DW, et al. Clinical spotlight review for the management of choledocholithiasis. Surg Endosc. 2020;34:1482–91.

    Article  Google Scholar 

  16. Lee A, Min SK, Park JJ, et al. Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones. J Korean Surg Soc. 2011;81(2):128–33. https://doi.org/10.4174/jkss.2011.81.2.128.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Alexakis N, Connor S. Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones. HPB (Oxford). 2012;14(4):254–9.

    Article  Google Scholar 

  18. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013;9:CD003327.

    Google Scholar 

  19. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, et al. Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208. https://doi.org/10.1155/2009/840208.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Clayton ESJ, Connor S, Alexakis N, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93(10):1185–91.

    Article  CAS  Google Scholar 

  21. Poulose BK, Arbogast PG, Holzman MD. National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc. 2006;20(2):186–90.

    Article  CAS  Google Scholar 

  22. Rojas-Ortega S, Arizpe-Bravo D, Marin Lopez ER, et al. Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg. 2003;7(4):492–6.

    Article  Google Scholar 

  23. Thompson MH, Tranter SE. All-comers policy for laparoscopic exploration of the common bile duct. Br J Surg. 2002;89(12):1608–12.

    Article  CAS  Google Scholar 

  24. Wu X, Huang Z-J, Zhong J-Y, et al. Laparoscopic common bile duct exploration with primary closure is safe for management of choledocholithiasis in elderly patients. Hepatobiliary Pancreat Dis Int. 2019;18(6):557–61.

    Article  Google Scholar 

  25. Zheng C, Huang Y, Xie E, et al. Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surg Endosc. 2017;31(6):2541–7.

    Article  Google Scholar 

  26. Zhu J, Tu S, Yang Z, et al. Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis. Surg Endosc. 2020;34(4):1522–33.

    Article  Google Scholar 

  27. Shen F, Pawlik TM. Surgical management of choledocholithiasis: a disappearing skill. JAMA Surg. 2016;151(12):1130–1.

    Article  Google Scholar 

  28. Wandling MW, Hungness ES, Pavey ES, et al. Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg. 2016;151(12):1125–30.

    Article  Google Scholar 

  29. Ansaloni L, Pisano M, Coccolini F, et al. WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25.

    Article  CAS  Google Scholar 

  30. van Dijk AH, de Reuver PR, Besselink MG, et al. Assessment of available evidence in the management of gallbladder and bile duct stones: a systematic review of international guidelines. HPB. 2017;19(4):297–309.

    Article  Google Scholar 

  31. McAlister VC, Davenport E, Renouf E. Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database Syst Rev. 2007;(4):CD006233.

    Google Scholar 

  32. Xu J, Yang C. Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: a meta-analysis. BMC Gastroenterol. 2020;20(1):229.

    Article  CAS  Google Scholar 

  33. Khan MA, Khan Z, Tombazzi CR, et al. Role of cholecystectomy after endoscopic sphincterotomy in the management of choledocholithiasis in high-risk patients: a systematic review and meta-analysis. J Clin Gastroenterol. 2018;52(7):579–89.

    Article  Google Scholar 

  34. Gomi H, Takada T, Hwang TL, et al. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. J Hepatobiliary Pancreat Sci. 2017;24(6):310–8. https://doi.org/10.1002/jhbp.452.

    Article  PubMed  Google Scholar 

  35. Park CS, Jeong HS, Kim KB, et al. Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients. Hepatobiliary Pancreat Dis Int. 2016;15(6):619–25. https://doi.org/10.1016/s1499-3872(16)60130-3.

    Article  PubMed  Google Scholar 

  36. Kiriyama S, Kozaka K, Takada T, et al. Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25:17–30.

    Article  Google Scholar 

  37. Kiriyama S, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2012;19:548–56.

    Article  Google Scholar 

  38. Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25:3–16.

    Article  Google Scholar 

  39. Mukai S, Itoi T, Baron TH, et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo guidelines 2018. J Hepatobiliary Pancreat Sci. 2017;24(10):537–49.

    Article  Google Scholar 

  40. Day LW, Lin L, Somsouk M. Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis. Endosc Int Open. 2014;2(1):E28–36. https://doi.org/10.1055/s-0034-1365281.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zhu B, Li D, Ren Y, et al. Early versus delayed laparoscopic common bile duct exploration for common bile duct stone-related nonsevere acute cholangitis. Sci Rep. 2015;5:11748. https://doi.org/10.1038/srep11748.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gholipour C, Shalchi RA, Abassi M. Efficacy and safety of early laparoscopic common bile duct exploration as primary procedure in acute cholangitis caused by common bile duct stones. J Laparoendosc Adv Surg Tech A. 2007;17(5):634–8.

    Article  Google Scholar 

  43. Atstupens K, Plaudis H, Fokins V, et al. Safe laparoscopic clearance of the common bile duct in emergently admitted patients with choledocholithiasis and cholangitis. Korean J Hepatobiliary Pancreat Surg. 2016;20(2):53–60.

    Article  Google Scholar 

  44. Jia B, Jin Z, Han W, et al. Safety and efficacy of emergency laparoscopic common bile duct exploration in elderly patients with complicated acute cholangitis. Surg Endosc. 2020;34(3):1330–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency Surgery Unit, Parma University Hospital, Parma, Italy

    Gennaro Perrone & Fausto Catena

  2. Gastroenterology and Endoscopy Unit, Parma University Hospital, Parma, Italy

    Federica Gaiani & Gian Luigi de’ Angelis

  3. General Surgery Unit, Parma University Hospital, Parma, Italy

    Andrea Morini & Mario Giuffrida

  4. Division of General Surgery, ASL VT - Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Italy

    Fabio Cesare Campanile

Authors
  1. Gennaro Perrone
    View author publications

    Search author on:PubMed Google Scholar

  2. Federica Gaiani
    View author publications

    Search author on:PubMed Google Scholar

  3. Andrea Morini
    View author publications

    Search author on:PubMed Google Scholar

  4. Mario Giuffrida
    View author publications

    Search author on:PubMed Google Scholar

  5. Gian Luigi de’ Angelis
    View author publications

    Search author on:PubMed Google Scholar

  6. Fausto Catena
    View author publications

    Search author on:PubMed Google Scholar

  7. Fabio Cesare Campanile
    View author publications

    Search author on:PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of General Surgery, ULSS2 Trevigiana del veneto, Vittorio Veneto (TV), Italy

    Ferdinando Agresta

  2. Policlinico Universitario Duilio Casula, AOU Cagliari, Department of Emergency Surgery, Monserrato, Italy

    Mauro Podda

  3. General Surgery, Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Viterbo, Italy

    Fabio Cesare Campanile

  4. Department of Emergency Surgery, AOU Careggi, Firenze, Italy

    Carlo Bergamini

  5. UO di chirurgia Generale e Toracica, AOU Ferrara, Ferrara, Italy

    Gabriele Anania

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Perrone, G. et al. (2021). Cholangitis and Choledocholithiasis. In: Agresta, F., Podda, M., Campanile, F.C., Bergamini, C., Anania, G. (eds) Emergency laparoscopic surgery in the elderly and frail patient. Springer, Cham. https://doi.org/10.1007/978-3-030-79990-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-79990-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-79989-2

  • Online ISBN: 978-3-030-79990-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics