Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography <i>versus</i> laparoscopic bile duct exploration in patients with choledocholithiasis

Poh, Benjamin Ruimin; Ho, S. P. S.; Sritharan, Mithra; Yeong, C.; Swan, Michael P.; Devonshire, David; Cashin, Paul; Croagh, Daniel

doi:10.1002/bjs.10207

Cited by 40 publications

(42 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The trials were published between 1996 and 2016. And 2 of the 11 trials were conducted in multicenter countries, [ 27 , 31 ] and the others were conducted in Egypt, [ 25 ] China, [ 26 ] UK, [ 28 , 32 ] India, [ 29 , 35 ] USA, [ 30 ] Australia, [ 33 ] and Turkey. [ 34 ] The sample size of the enrolled patients ranged from 30 to 300, with a total number of 1663.…”

Section: Resultsmentioning

confidence: 99%

“…[ 34 ] The sample size of the enrolled patients ranged from 30 to 300, with a total number of 1663. Among the included studies, 3 trials [ 25 , 26 , 33 ] used 1-stage EST and LC for patients with gallstones and CBD stones; whereas the remaining 8 trials [ 27 – 32 , 34 , 35 ] used 2-stage EST followed by LC. Notably, in the trial conducted by Noble et al [ 32 ] patients enrolled were with higher medical risk; whereas, in other studies, patients were with a good-risk.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones

Gao¹,

Chen

Qin

et al. 2017

Medicine

View full text Add to dashboard Cite

Background:The purpose of this study was to compare the efficacy and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct (CBD) stones exploration (LCBDE) with LC plus endoscopic sphincterotomy (EST) in the treatment of patients with gallstones and CBD stones.Methods:The authors searched PubMed, Web of Science, and Embase to identify relevant studies. Risk ratios (RRs) were pooled to compare stone clear, retained stone, conversion to other procedures, and complications. Weighted mean differences (WMDs) were pooled to compare operative time, and length of hospital stay. A fixed-effects model or random-effects model was used to pool the estimates, according to the heterogeneity among the included studies.Results:A total of 11 randomized controlled trials (RCTs) involving 1663 patients were included in this meta-analysis. The pooled estimate suggested that LC-LCBDE had comparable effects with LC-EST in terms of CBD stone clear rate (RR = 1.02, 95% CI: 0.95, 1.09; P = .583), retained stones rate (RR = 1.27, 95% CI: 0.51, 3.19; P = .607), and length of hospital stay (WMD = −0.96 days, 95% CI: −2.20, 0.28). In addition, LC-LCBDE was associated with significantly higher conversion rate (RR = 1.59, 95% CI: 1.08, 2.35; P = .019) and less operative time (WMD = −11.55 minutes, 95% CI: −16.68, −6.42; P < .001) than LC-EST. The incidence of complications was not significant difference between the 2 surgical approaches (RR = 1.07, 95% CI: 0.86, 1.34; P = .550).Conclusion:Based on the current evidence, both LC-LCBDE and LC-EST were highly effective in detecting and removing CBD stones and were equivalent in complications. However, our results might be biased by the limitations. Large-scale well-designed RCTs are needed to confirm our findings.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones

Gao¹,

Chen

Qin

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

“…With the development of technology, LCBDE, as an extension of LC, since it was first reported in the 1990s, has been proven to be safe, effective, and minimally invasive, and it does not cause damage to the sphincter of Oddi [1,2,17,19]. Aawsaj et al [8] reported that laparoscopy combined with choledochoscopy is an effective, feasible, and safe technique for the treatment of concomitant gallbladder stones and CBD stones and is associated with fewer complications.…”

Section: Discussionmentioning

confidence: 97%

“…Moreover, as calculi cannot be successfully removed with ERCP, the patients need to undergo an additional procedure or EST. EST and ERCP can cause damage to the function of the sphincter of Oddi, which may result in short-term complications (perforation, bleeding, and pancreatitis) and long-term complications (recurrent refluxing cholangitis and bile duct stenosis) [17]. Therefore, it is important to preserve the function of the sphincter of Oddi.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions

Wang

et al. 2017

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…However, it can require the use of laparoscopic choledochotomy, with a risk of bile leak up to 15%, especially in patients with non-dilated CBD, and in the presence of inflammation [20]. In addition, the ERCP stone clearance rate appears higher than that after laparoscopic bile duct exploration [21, 22]. …”

Section: Discussionmentioning

confidence: 99%

Management of suspected common bile duct stones on cholangiogram during same-stay cholecystectomy for acute gallstone-related disease

et al. 2017

View full text Add to dashboard Cite

BackgroundRecent data have suggested that upfront cholecystectomy should be performed even in the presence of moderately abnormal liver function tests (LFTs). As a consequence, more common bile duct (CBD) stones are discovered on intra-operative cholangiogram. We assessed the presentation and management of such patients to refine their management plan.MethodsAdult patients (>16 years) with an acute gallstone-related disease who had undergone same-stay cholecystectomy from January 2013 to January 2015 were retrospectively assessed. We excluded patients with pre-operative endoscopic CBD exploration.ResultsAmong the 612 patients with same-stay cholecystectomy, 399 patients were included in the study, and 213 were excluded because of a pre-operative CBD exploration. Fifty patients (12.5%) presented an image of CBD stone on the intra-operative cholangiogram. Such patients were younger (47 vs. 55 years, P = .01) and less likely to present with fever (1 vs. 11.7%, P = .04) or signs of cholecystitis on ultrasound (66 vs. 83.7%, P = .003). Admission LFTs were higher in patients with an image of a stone. Among the 50 patients with an image on cholangiogram, a stone was confirmed in 26 (52%). Most patients (n = 32) underwent post-operative assessment with endoscopic ultrasound (EUS). LFTs did not predict the presence of a confirmed stone. However, the absence of contrast passage into the duodenum was negatively associated with a confirmed stone (P = .08), and a filling defect was positively associated with one (P = .11). Most confirmed stones were successfully extracted by endoscopic retrograde cholangiopancreatogram (ERCP) (25/26, 96%), except in one patient who needed a per-cutaneous approach because of duodenal diverticuli.ConclusionsSame-stay cholecystectomy can (and should) be performed even in the presence of moderately abnormal liver function tests. The cholangiogram suspicion of a CBD stone is confirmed in only half of the patients (more often in the presence of a filling defect, and less often with the absence of contrast passage). All stones can be safely treated after surgery (most by ERCP).Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-017-0232-z) contains supplementary material, which is available to authorized users.

show abstract

Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis

Abstract: ACTRN12613000761763 (http://www.anzctr.org.au/).

Cited by 40 publications

References 22 publications

Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones

Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones

Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions

Management of suspected common bile duct stones on cholangiogram during same-stay cholecystectomy for acute gallstone-related disease

Contact Info

Product

Resources

About