Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones: a meta-analysis

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Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones : a meta-analysis

Mc Geehan, Gearóid (author): Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland; School of Medicine, University of Limerick, Limerick, Ireland

Melly, Conor (author): Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland; School of Medicine, University of Limerick, Limerick, Ireland

O' Connor, Niall (author): Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland

Bass, Gary (author): Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, USA

Mohseni, Shahin, 1978- (author): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden

Bucholc, Magda (author): Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University (European Union Interreg VA Funded), Magee Campus, Northern Ireland, UK

Johnston, Alison (author): Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland; EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland

Sugrue, Michael (author): Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland; Department of Surgery, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland; EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland

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2022-09-02
2023
English.
In: European Journal of Trauma and Emergency Surgery. - : Urban und Vogel Medien und Medizin Verlagsgesellsc. - 1863-9933 .- 1863-9941. ; 49:5, s. 2257-2267

Related links:: https://doi.org/10.1...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Research review (peer-reviewed)

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BACKGROUND: Symptomatic calculus biliary disease is common with associated morbidity and occasional mortality, further confounded when there is concomitant common bile duct (CBD) stones. Choledocholithiasis and clearance of the duct reduces recurrent cholangitis, but the question is whether after clearance of the CBD if there is a need to perform a cholecystectomy. This meta-analysis evaluated outcomes in patients undergoing ERCP with or without sphincterotomy to determine if cholecystectomy post-ERCP clearance offers optimal outcomes over a wait-and-see approach.METHODS: A Prospero registered meta-analysis of the literature using PRISMA guidelines incorporating articles related to ERCP, choledocholithiasis, cholangitis and cholecystectomy was undertaken for papers published between 1st January 1991 and 31st May 2021. Existing research that demonstrates outcomes of ERCP with no cholecystectomy versus ERCP and cholecystectomy was reviewed to determine the related key events, complications and mortality of leaving the gallbladder in situ and removing it. Odds ratios (OR) were calculated using Review Manager Version 5.4 and meta-analyses performed using OR using fixed-effect (or random-effect) models, depending on the heterogeneity of studies.RESULTS: 13 studies (n = 2598), published between 2002 and 2019, were included in this meta-analysis, 6 retrospective, 2 propensity score-matched retrospective studies, 3 prospective studies and 2 randomised control trials from a total of 11 countries. There were 1433 in the no cholecystectomy cohort (55.2%) and 1165 in the prophylactic cholecystectomy (44.8%) cohort. Cholecystectomy resulted in a decreased risk of cholecystitis (OR = 0.15; CI 0.07-0.36; p < 0.0001), cholangitis (OR = 0.51; CI 0.26-1.00; p = 0.05) and mortality (OR = 0.38; CI 0.16-0.9; p = 0.03). In addition, prophylactic cholecystectomy resulted in a significant reduction in biliary events, biliary pain and pancreatitis.CONCLUSIONS: In patients undergoing CBD clearance, consideration should be given to performing prophylactic cholecystectomy to optimise outcomes.

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By the author/editor: Mc Geehan, Gearó ...; Melly, Conor; O' Connor, Niall; Bass, Gary; Mohseni, Shahin, ...; Bucholc, Magda; show more...; Johnston, Alison; Sugrue, Michael; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

Articles in the publication: European Journal ...

By the university: Örebro University

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Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones : a meta-analysis

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