Comparative efficacy of various endoscopic techniques for the treatment of common bile duct stones: a network meta-analysis

Park, Chan Hyuk; Jung, Jang Han; Nam, Eunwoo; Kim, Eun Hye; Kim, Mi Gang; Kim, Jae Hyun; Park, Se Woo

doi:10.1016/j.gie.2017.07.038

Cited by 61 publications

(66 citation statements)

References 53 publications

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“…Post ERCP complications vary widely in the literature between 5 and 38%; due to pancreatitis, duodenal perforation, bleeding, cholangitis, and papillary stenosis [ 13 , 18 , 32 , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] ] It was 9.4%, 11%, and 11.1% in ours, Tai et al, 2004 [ 19 ], and Koc et al, 2013 [ 34 ] studies respectively. Where our ERCP was complicated with pancreatitis, bleeding, cholangitis, and impacted dormia in 3.5%, 2.4%, 2.4%, and 1.2% of patients respectively.…”

Section: Discussionmentioning

confidence: 62%

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Gad

Zakaria

Kamel

et al. 2019

Annals of Medicine and Surgery

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Objectives For complicated common bile duct stones (CBDS) that cannot be extracted by endoscopic retrograde cholangiopancreatography (ERCP), management can be safely by open or laparoscopic CBD exploration (CBDE). The study aimed to assess these surgical procedures after endoscopic failure. Methods We analyzed 85 patients underwent surgical management of difficult CBDS after ERCP failure, in the period from 2013 to 2018. Results Sixty-seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively. An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBDE(LCBDE), open CBDE(OCBDE) and the converted cases were 24.7% (n = 21), 70.6% (n = 60), and 4.7% (n = 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively, Eleven (12.9%) of our patients had postoperative complications without mortality. By comparing LCBDE and OCBDE; there was a significant association between the former and longer operative time. On comparing, T-tube and 1ry CBD closure in both OCBDE and LCBDE, there was significantly longer operative time, and post-operative hospital stays in the former. Furthermore, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time, and post-operative hospital stay. Conclusion Large difficult CBDS can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay.

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Section: Discussionmentioning

confidence: 62%

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Gad

Zakaria

Kamel

et al. 2019

Annals of Medicine and Surgery

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“…Posterior studies have revealed the promising effect of sphincterotomy associated with balloon dilation of papilla in choledocholithiasis[ 22 - 26 ]. Inversely proportional is the number of published articles comparing single dilation to any other method.…”

Section: Discussionmentioning

confidence: 99%

“…Only seven articles with 1253 patients compared EST to ESBD, the two methods that our review compares, since it is not part of the current guidelines the isolated use of balloon dilation, except in selected cases of irreversible coagulopathy. Among the seven selected, Stefanidis’s above-mentioned work is present[ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is worth to mention that its result was generated from a separated analysis with only three RCTs selected with a total of 355 patients, of which 155 were extracted from a single clinical trial that addressed only patients with periampullary diverticulum, adding an important selection bias to the analysis[ 28 ]. The recently published meta-analysis by Park CH did not observe this difference in bleeding risk between ESBD and EST, but obtained that both ESBD and EST had more bleeding than EPBD[ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones: A systematic review and meta-analysis based on randomized controlled trials

Clemente

Bernardo

Franzini

et al. 2018

WJGE

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AIMTo compare gallstones removal rate and incidence of bleeding, pancreatitis, use of mechanical lithotripsy, cholangitis and perforation between isolated sphincterotomy vs sphincterotomy associated with balloon dilation of papilla in choledocholithiasis through the meta-analysis of randomized clinical trials.METHODSWe conducted a systematic review according to the PRISMA guidelines. Literature search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane Library, LILACS, and EMBASE database platforms in July 2017. The manual search included references of retrieved articles. We extracted data focusing on outcomes: The primary endpoint was the stones removal rate; Secondary endpoints were rates of pancreatitis, bleeding, use of mechanical lithotripsy (ML), perforation and cholangitis.RESULTSEleven RCTs with 1824 patients were included. EST was associated with more post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding [FE RD-0.02, CI (-0.03, -0.00), I2 = 33%, P = 0.05] and more need of mechanical lithotripsy in general [RE RD-0.16, CI (-0.25, -0.06), I2 = 90%, P = 0.002] and in subgroup analysis of stones greater than 15 mm [RE RD-0.20, CI (-0.38, -0.02), I2 = 82%, P = 0.003]. Incidence of pancreatitis [FE RD-0.01, CI (-0.03, 0.01), I2 = 0, P = 0.36], cholangitis [FE RD-0.00, CI (-0.01, 0.01), I2 =0, P = 0.97] and perforation [FE RD-0.01, CI (-0.01, 0.00), I2 = 0, P = 0.23] was similar between the groups as well as similar stone removal rates in general [FE RD-0.01, CI (-0.01, 0.04), I2 = 0, P = 0.23] and pooled analysis of stones greater than 15 mm [FE RD-0.02, CI (-0.02, 0.07), I2 = 11%, P = 0.31].CONCLUSIONThrough meta-analysis of randomized clinical trials we found that isolated sphincterotomy was associated with more post-ERCP bleeding and more need for mechanical lithotripsy. However, there was no statistical difference in the stone removal rate between isolated sphincterotomy and sphincterotomy associated with balloon dilation in the approach to remove gallstones.

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“…Classen rst reported ES for the treatment of bile duct stones in 1974 [5]. ES subsequently became the mainstream treatment for common bile duct stones [6,7].…”

Section: Introductionmentioning

confidence: 99%

Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: A meta-analysis

Yang

2020

Preprint

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Background Endoscopic sphincterotomy is the standard treatment for common bile duct stones.There is different evidence considering complications specifically biliary pancreatitis and cholangitis with the use of cholecystectomy after endoscopic sphincterotomy.The purpose of this article is to compare the positive cholecystectomy after endoscopic treatment of common bile duct stones, whether the incidence of recurrent pancreatitis cholangitis is reduced, especially in high-risk patients. Methods We searched Pubmed(1990-2019)、Embase(1990-2019)和 Cochrane(1990-2019)database for trials comparing the 2 strategies for gallstones after ES.A related article on the removal of gallbladder after endoscopic sphincterotomy was collected,followed by analysis of each group using RevMan. Results We have adopted a total of 8 studies, including 7 randomized controlled trials and 1 retrospective study. A total of 12718 patients were included in the study, 4922 in the early cholecystectomy group, and 7795 in the gallbladder in situ group.During the follow-up period, 41 patients had pancreatitis after endoscopic sphincterotomy in the cholecystectomy group, and 177 patients in the wait-and-see group. The incidence of pancreatitis in the gallbladder in situ group was significantly reduced(RR 0.38, 95%CI 0.27 to 0.53, P < 0.00001,I 2 =0%).The incidence of cholangitis and jaundice in the removal of the gallbladder group was also less than that in the preserved gallbladder group(RR 0.31, 95%CI 0.26 to 0.38, P < 0.00001,I 2 =0%).There was no significant difference in mortality between the two groups(RR 0.73, 95%CI 0.52 to 1.02, P =0.07,I 2 =14%).There is a significant difference in cholecystitis or biliary colic(RR 0.25, 95% CI 0.21 to 0.29, P < 0.00001,I 2 =28%). Conclusions Early endoscopic cholecystectomy after removal of common bile duct stones can effectively reduce biliary complications such as recurrent pancreatitis, cholangitis and cholecystitis. This is still true for high-risk patients, and has no significant effect on the mortality of patients. After ES,laparoscopic cholecystectomy should be recommended.

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Comparative efficacy of various endoscopic techniques for the treatment of common bile duct stones: a network meta-analysis

Cited by 61 publications

References 53 publications

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones: A systematic review and meta-analysis based on randomized controlled trials

Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: A meta-analysis

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