Aims: To analyse the results of endoscopic treatment of bile duct (BD) stones without subsequent cholecystectomy in patients over 64 years old or those unfit for surgery.

Methods: All consecutive patients undergoing endoscopic bile duct clearance during six years to 31.12.98 were analysed from various prospectively collected data sources. Statistical analysis—chi-squared test with Yate's correction.

Results: 174 patients were included (median age of 76 years) of whom 13 were <65 years but were unfit for surgery (age range 49–64). Successful endoscopic sphincterotomy (ES) was achieved in 93% of patients but 29 required surgery to clear the bile duct. Following endoscopic duct clearance, 143 patients were discharged with gallbladders in situ. Mean follow-up was 41.2 months. 15% required subsequent cholecystectomty (due to acute cholecystitis in 8 and recurrent biliary colic in 8 patients). 13% required further endoscopic BD surgery. There was no recurrence of biliary pancreatitis. 58% of patients in the age group 65–70 yrs at initial presentation required subsequent intervention (SI) as compared to 19.5% in patients over 70 (p value = 0.0003). Overall complication rate of ERCP/ES was 5%.

Conclusions: ERCP/ES alone without subsequent cholecystectomy is safe and effective for treating high-risk patients with choledocholithiasis, effectively prevents recurrence of biliary pancreatitis and does not increase the risk of subsequent acute cholecystitis. Subsequent cholecystectomy rate of 15% is higher than <11% previously reported. More than 50% patients in 65–70 yrs age group will need further treatment after endoscopic BD clearance. Majority of SI take will place in first 2 years following endoscopic BD clearance. Rate of SI is not related to the length of follow-up. Comparison with laparoscopic bile duct surgery is needed.