Endoscopic retrograde cholangiopancreatography versus surgery for choledocholithiasis – A meta-analysis

Abstract

Introduction and Objectives: There is no consensus on the best treatment option for choledocholithiasis. Therefore, the aim of this study was to compare endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct surgery (CBDS) for the treatment of choledocholithiasis. Materials and methods: We performed a systematic review of randomized controlled trials (RCTs) comparing ERCP and CBDS in the treatment of choledocholithiasis. MEDLINE and EMBASE were the used databases. RCTs assessing mortality, bile duct clearance failure, complications, or length of hospital stay were considered eligible. Meta-analysis was performed using random effects model, through the Mantel–Haenszel method for binary outcomes and through the inverse variance method for continuous outcomes. The quality of the evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. The study protocol was registered at the PROSPERO platform (CRD42017073196). Results: Nineteen RCTs (2466 patients) were included in the meta-analysis. There was no evidence of significant difference between interventions regarding mortality (risk ratio – RR = 1.31, 95% confidence interval – 95% CI = 0.60–2.85, p = 0.49), bile duct clearance failure (RR = 1.17, 95% CI = 0.86–1.59, p = 0.31), complications (RR = 0.99, 95% CI = 0.82–1.20, p = 0.94) and length of hospital stay (weighted mean difference – MD = 1.06, 95% CI = −0.62–2.73, p = 0.22). Sensitivity analyses failed to demonstrate significant changes in results compared to the main analyses. The quality of the evidence was considered to be low. Conclusion: There was no evidence of significant difference between ERCP and CBDS for the treatment of choledocholithiasis.

Keywords

• Endoscopic retrograde cholangiopancreatography
• Choledocholithiasis
• Bile duct surgery
• Systematic review
• Meta-analysis