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Expectant Management An Option For Bile Stones

Initially less costly and has similar outcome to elective cholecystectomy in elderly patients

THURSDAY, April 13 (HealthDay News) -- Expectant management after endoscopic retrograde cholangiography with sphincterotomy (ERC-S) for common bile duct stones may be a reasonable strategy in elderly patients, but it depends on the probability of recurrent symptoms, according to a study in the April issue of the American Journal of Gastroenterology.

Britt B. Drake, M.D., of the University of Alabama at Birmingham, and colleagues constructed a decision tree to estimate the costs and outcomes associated with two treatment strategies following ERC-S for common bile duct stones in patients aged 60 or older: elective cholecystectomy and expectant management.

The researchers found that elective cholecystectomy was associated with total costs of $5,259, with 94.3 percent of the cohort alive (1.886 life-years) at two years. Expectant management was associated with total costs of $1,173, with 94.7 percent of the cohort alive (1.894 life-years) after two years. They also found that expectant management became less effective and more expensive at a yearly probability of recurrent symptoms greater than 40 percent and 90 percent, respectively, compared to elective cholecystectomy.

"This study should not direct policy or be used to deny a patient cholecystectomy after endoscopic retrograde cholangiopancreatography with sphincterotomy for common bile duct stones," states the author of an accompanying editorial. "It could, however, help the parties involved make a reasoned decision."

The study was supported by a grant from TAP Pharmaceutical Inc.

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