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Surgical Endoscopy

, Volume 27, Issue 7, pp 2454–2465 | Cite as

Preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones: system review and meta-analysis

  • Bin Wang
  • Zhenying Guo
  • Zhenjie LiuEmail author
  • Yuan Wang
  • Yi Si
  • Yuefeng Zhu
  • Mingjuan Jin
Article

Abstract

Background

Conducting preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones remains controversial. We conducted a meta-analysis to evaluate the outcomes of preoperative endoscopic sphincterotomy (POES) versus intraoperative endoscopic sphincterotomy (IOES).

Methods

We searched multiple electronic databases for prospective, randomized, controlled trials related to safety and effectiveness of POES versus IOES. Relative risk ratios (RRs) were estimated with 95 % confidence intervals (CI) based on an intention-to-treat analysis. We considered the following outcomes: clearance rate, postprocedural complications, and hospital stay.

Results

Five trials with 631 patients (318 with POES, 313 with IOES) were analyzed. Although the overall rates of common bile duct stone clearance were similar between POES and IOES (RR 0.96, 95 % CI 0.91–1.01; p = 0.13), the failure rate of common bile duct cannulation during endoscopic retrograde cholangiopancreatography (ERCP) was significantly higher for IOES (RR 2.54, 95 % CI 1.23–5.26; p = 0.01). The pooled RR after POES for overall complication rates was similar to that for IOES (RR 1.56, 95 % CI 0.94–2.59; p = 0.09). However, compared with IOES, the RR risk of ERCP-related complications was significantly higher for POES (RR 2.27, 95 % CI 1.18–4.40, p = 0.01), especially in the patients at high risk of developing post-ERCP pancreatitis. There was no significant difference in morbidity after laparoscopic cholecystectomy or required subsequent open surgery between the two groups. In the subgroup analyses, the RR risks of post-ERCP pancreatitis were significantly higher for POES (RR 4.85, 95 % CI 1.41–16.66, p = 0.01), and mean hospital stay was longer in the POES group (RR 2.22, 95 % CI 1.98–246; p < 0.01). However, the rates of bleeding, perforation, cholangitis, cholecystitis, and gastric ulceration did not differ significantly between POES and IOES.

Conclusions

With regard to the stone clearance and overall complication rates, POES is equal to IOES in patients with gallbladder and common bile duct stones. However, IOES is associated with a reduced incidence of ERCP-related pancreatitis and results in a shorter hospital stay.

Keywords

Cholecystodocholithiasis Endoscopic retrograde cholangiopancreatography Endoscopic sphincterotomy Laparoscopic cholecystectomy 

Notes

Disclosures

Drs. B. Wang, Z. Y. Guo, Z. J. Liu, Y. Wang, Y. Si, Y. F. Zhu, and M. J. Jin have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Bin Wang
    • 1
  • Zhenying Guo
    • 2
  • Zhenjie Liu
    • 3
    • 4
    Email author
  • Yuan Wang
    • 5
  • Yi Si
    • 4
  • Yuefeng Zhu
    • 3
  • Mingjuan Jin
    • 6
  1. 1.Department of SurgeryDongyang People’s HospitalZhejiangChina
  2. 2.Department of PathologyZhejiang Cancer HospitalHangzhouChina
  3. 3.Department of General SurgerySir Run Run Shaw Hospital, Zhejiang UniversityHangzhouChina
  4. 4.Department of Surgery, WIMRUniversity of Wisconsin-MadisonMadisonUSA
  5. 5.Department of SurgeryDongyang Traditional Medical HospitalZhejiangChina
  6. 6.Department of BiostatisticsZhejiang UniversityHangzhouChina

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