Medical Management of Uncomplicated Symptomatic Small Gallstones in Elderly.

Autor: Doğan, Yüksel, Oğullar, Sabri
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Zdroj: Indian Journal of Surgery; Aug2024, Vol. 86 Issue 4, p736-740, 5p
Abstrakt: Octogenarian and nonagenarian subjects with incidentally detected uncomplicated or symptomatic small gall stones may be treated without adverse outcomes of septicaemia and perforation with oral ursodeoxycholic avoiding surgery. Ninety-six subjects—64 men, 32 women, age > 65, with symptoms of acute or chronic cholecystitis having small gallstones < 15 mm or biliary sludge, high surgical risk of American Society of Anaesthesiologists (ASA) 3–4—were given 12–15 mg/kg/day ursodeoxycholic acid for 12–18 months. Clinical monitoring with liver function testing and ultrasonographic evaluation at 3 monthly interval and magnetic cholangiopancreatography per 6 months were done. Outcomes were evaluated in this cross sectional study. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase(ALP) values decreased significantly. Clinical, ultrasonographic and magnetic cholangiopancreatography evaluation at regular intervals showed improvement in all subjects which was not statistically significant. Fifty percent of gallstones smaller than 5–10 mm, 70% of stones smaller than 5 mm and bile sludge were successfully dissolved in all subjects. The success rate in patients with stones larger than 10 mm or multiple stones was low (8–10%). There were no severe side effects except mild diarrhoea, and 4% of patients underwent surgery and endoscopic retrograde cholangiopancreatography during the period of this study. Ursodeoxycholic acid medical treatment may be an alternative to cholecystectomy in octogenarian and nonagenarian subjects with incidentally detected uncomplicated or symptomatic small gallstones or those who refuse surgery. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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