Management Post-ERCP Removal of Stone in a 76-Year-Old Debilitated Man: Does He Need Cholecystectomy?

A 76-year-old debilitated man presented with epigastric pain. His serum biochemistry was as follows: bilirubin level, 3.98 mg/dL (<0.88 mg/dL); alkaline phosphatase level, 361 IU/L (30–80 IU/L); alanine aminotransferase level, 382 IU/L (<58 IU/L), and amylase level, 4709 U/L (28–100 U/L). The hemoglobin level was 10.9 g/dL (11.5–14.3 g/dL), and the total white cell count was 13.2 × 109/L (4–10.8 × 109/L). Endoscopic retrograde cholangiopancreatography (ERCP) showed an impacted stone at the ampulla of Vater (Figure 1). A needle knife sphincterotomy was performed. The stone was disimpacted and the bile duct was decompressed. An ultrasound scan performed during his admission showed multiple small gallstones in a thick-walled gallbladder. Does he need a cholecystectomy?

View Large Image Download to PowerPoint

Figure 1. Algorithm to determine if cholecystectomy should be performed after ERCP-facilitated stone extraction.