Published online Jun 7, 2026. doi: 10.3748/wjg.v32.i21.117971
Revised: January 27, 2026
Accepted: March 10, 2026
Published online: June 7, 2026
Processing time: 154 Days and 19.8 Hours
Symptomatic gallstone disease (SGD) is a leading cause of gastrointestinal hospitalizations with the incidence and severity positively correlated with age. Although early cholecystectomy is the recommended treatment, elderly patients are often managed conservatively due to comorbidities and surgical risk. There is limited data on the recurrence patterns of SGD in the elderly population.
To characterize the clinical features, recurrence patterns, and predictors of recurrence in elderly patients with SGD who were managed non-operatively.
A post hoc analysis was conducted using data from the multicenter RELAPSTONE cohort. The cohort included 3016 patients admitted with the first episode of SGD and did not undergo cholecystectomy during the index admission. Patients with prior biliary events or previous cholecystectomy were excluded. We defined elderly as an age ≥ 80 years. Demographic, clinical, laboratory, and imaging data were collected. Recurrence-free survival was analyzed using Kaplan-Meier curves. Multivariable Cox regression was utilized to identify independent predictors of recurrence.
Among the 3016 patients, 1087 (36.0%) were ≥ 80 years (median 86.5). At the index admission elderly patients had a higher comorbidity burden and more severe acute cholecystitis and cholangitis. Recurrence was less frequent in elderly patients (hazard ratio = 0.70; 95%CI: 0.61-0.80; P = 0.001), and recurrences occurred later in elderly patients (median 3.4 months vs 1.8 months; P < 0.001). However, elderly patients experienced more frequent multiple (51.7% vs 39.7%; P < 0.001) and more severe episodes, particularly for acute cholecystitis and cholangitis. The recurrence pattern differed between the elderly and non-elderly patients. The most frequent recurrence among the elderly patients was acute cholecystitis (29.7%). Independent protective factors against recurrence included prior endoscopic retrograde cholangiopancreatography with sphincterotomy and a higher level of white blood cell at the index admission.
SGD in elderly patients exhibited distinct clinical patterns with fewer but more severe episodes and age-specific recurrence patterns. Our findings could enable risk stratification to guide age-adapted interventions.
Core Tip: Recurrence patterns after symptomatic gallstone disease in elderly patients is scarce. This multicenter study showed that patients ≥ 80 years who were managed conservatively after the index admission followed a distinct clinical course. Although the elderly patients experienced less frequent recurrences, they did experience multiple episodes more frequently that tended to occur later and be more severe. Prior endoscopic retrograde cholangiopancreatography with sphincterotomy was associated with a reduced risk of recurrence. These findings provided novel age-specific data to improve risk stratification that can tailor management strategies in this growing population.