Supplementary Material for: Is cholecystectomy necessary after choledocholithiasis treatment for the elderly or patients with many comorbidities?

Introduction: We evaluated the prognosis after endoscopic treatment for choledocholithiasis, particularly in patients with borderline tolerance to surgery. Stone removal and cholecystectomy are generally recommended for patients with choledocholithiasis combined with gallstones to prevent recurrent biliary events. However, the prognosis after choledocholithiasis treatment in patients with borderline tolerance to surgery, such as the elderly or those with many comorbidities, remains controversial. Methods: We retrospectively analyzed data from patients with choledocholithiasis treated at our facility between January 2012 and December 2021. Patients who underwent endoscopic sphincterotomy were dichotomized into the cholecystectomy (CHOLE) and conservation (CONS) groups depending on whether cholecystectomy was performed, and their prognoses were subsequently compared. Furthermore, we performed a logistic regression analysis of the factors contributing to recurrent biliary events in patients with high age-adjusted Charlson Comorbidity Index (aCCI) scores. Results: Of 169 participants, 110 had gallstones and were divided into the CHOLE (n=56) and CONS (n=54) groups. The CONS group was significantly ordered, had more comorbidities, and higher aCCI scores, whereas the CHOLE group had fewer recurrent biliary events, although not significant (P= 0.122). No difference was observed in the recurrent incidence of grade ≥ 2 biliary infections and mortality related to biliary events between the groups. In patients with aCCI scores ≥ 5, conservation without cholecystectomy was not an independent risk factor for recurrent biliary events. Conclusion: Cholecystectomy after choledocholithiasis treatment prevents recurrent biliary events, but conservation without cholecystectomy is a feasible option for patients with high aCCI scores.引言：本研究评估了胆总管结石病（choledocholithiasis）患者接受内镜治疗（endoscopic treatment）后的预后情况，尤其聚焦于手术耐受边界状态的患者群体。对于合并胆囊结石的胆总管结石病患者，临床通常推荐行结石取出术联合胆囊切除术（cholecystectomy），以预防复发性胆道事件（recurrent biliary events）的发生。然而，对于手术耐受边界状态的患者（如老年群体或合并多种基础疾病者），接受胆总管结石病治疗后的预后情况仍存在争议。 方法：本研究回顾性分析了2012年1月至2021年12月期间，本医疗机构收治的胆总管结石病患者的临床数据。所有接受内镜下括约肌切开术（endoscopic sphincterotomy）的患者，根据是否行胆囊切除术被分为胆囊切除术组（CHOLE组）与保守治疗组（CONS组），随后对比两组患者的预后情况。此外，针对年龄校正查尔森合并症指数（age-adjusted Charlson Comorbidity Index, aCCI）评分较高的患者，本研究开展了logistic回归分析，以明确复发性胆道事件的相关影响因素。 结果：本研究共纳入169例受试者，其中110例合并胆囊结石，被分为CHOLE组（n=56）与CONS组（n=54）。保守治疗组患者年龄更大、合并症更多，且aCCI评分更高；而CHOLE组的复发性胆道事件发生率更低，尽管该差异未达到统计学显著性（P=0.122）。两组患者的≥2级胆道感染复发率及胆道事件相关死亡率均无显著差异。对于aCCI评分≥5的患者，未行胆囊切除术的保守治疗并非复发性胆道事件的独立危险因素。 结论：胆总管结石病治疗后联合胆囊切除术可预防复发性胆道事件，但对于aCCI评分较高的患者，未行胆囊切除术的保守治疗仍是一种可行的治疗选择。