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Systematic review and meta‐analysis of minimally invasive techniques for the management of cholecysto‐choledocholithiasis
Author(s) -
Nagaraja Vinayak,
Eslick Guy D.,
Cox Michael R.
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.152
Subject(s) - endoscopic retrograde cholangiopancreatography , medicine , gallstones , meta analysis , laparoscopic cholecystectomy , odds ratio , confidence interval , randomized controlled trial , common bile duct , general surgery , cholecystectomy , surgery , pancreatitis
Background The optimal management of patients with symptomatic gallstones and possible or proven common bile duct ( CBD ) stones and gallstones is still evolving. Today a number of options exist: preoperative endoscopic retrograde cholangiopancreatography (pre‐op ERCP ), laparoscopic cholecystectomy ( LC ) combined with intraoperative endoscopic sphincterotomy ( IOES ), laparoscopic common bile duct exploration ( LCBDE ) and postoperative ERCP (post‐op ERCP ). This meta‐analysis was done to compare these management options and determine if any single option was clearly superior. Methods A systematic search was conducted using several electronic databases. The search revealed 15 randomized controlled trials ( RCT s). Six comparing pre‐op ERCP with LCBDE , five comparing pre‐op ERCP with IOES , two comparing IOES with LCBDE and two comparing post‐op ERCP with LCBDE , comprising a total of 1992 patients. Results The pre‐op ERCP group had a significantly higher incidence of ERCP related complications (odds ratio: 2.40, 95% confidence interval: 1.21–4.75). Conclusions The evidence provided by this meta‐analysis suggests that both of these approaches would appear comparable. To fully address which would be the better approach would require an RCT as discussed above.