Surgical versus endoscopic treatment of bile duct stones

Dasari, Bobby; Tan, Chuan Jin; Gurusamy, Kurinchi; Martín, David; Kirk, G.; McKie, Lloyd; Diamond, Tom; Mb, Taylor

doi:10.1002/14651858.cd003327.pub3

Cited by 242 publications

(279 citation statements)

References 112 publications

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“…Mortality rates during admissions in which endoscopic biliary sphincterotomies were done remained under 2%; this figure is similar to other previously published results (22). Additionally, we found no significant changes in mortality trends over time for any of both populations, which could be influenced by the low number of fatalities.…”

Section: Discussionsupporting

confidence: 91%

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

et al. 2016

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We aimed to compare incidence and outcomes for endoscopic biliary sphincterotomies in people with or without type 2 diabetes mellitus (T2DM) in Spain (2003Spain ( -2013.We collected all cases of endoscopic biliary sphincterotomies using national hospital discharge data and evaluated annual incidence rates stratified by T2DM status. We analyzed trends over time for in-hospital mortality (IHM) as the primary outcome and a composite of IHM or procedure-related complications (key secondary outcome). In multivariate analyses, we tested T2DM as an independent factor of IHM and IHM or complications.We identified 126,885 endoscopic biliary sphincterotomies (23,002 [18.1%] in T2DM people). Crude incidence rates of endoscopic biliary sphincterotomies were > 3-fold higher in people with vs without T2DM (85.5/10 5 vs 26.9/10 5 population, respectively). Annual incidence rates of endoscopic biliary sphincterotomies showed 11-year relative increments of 77.5% (from 60.0 to 106.5/105) in T2DM, and 53.7% (from 21.6 to 33.2/105) in non-T2DM people (p < 0.001). We found no significant changes in mortality trends over time for the populations with or without T2DM (p = 0.15 and p = 0.21, respectively). Rates of procedural pancreatitis decreased in people without T2DM (p < 0.001). In the multivariate analysis, older age, higher comorbidity and endoscopic biliary sphincterotomy during urgent admission were associated with a higher IHM. T2DM was associated with a lower IHM after an endoscopic biliary sphincterotomy Further studies are needed to confirm a lower IHM for endoscopic biliary sphincterotomies in people with T2DM.

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Section: Discussionsupporting

confidence: 91%

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

et al. 2016

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“…Prior randomized controlled trials have suggested that intra-operative CBD exploration during cholecystectomy is superior to the two-step pre-or post-cholecystectomy ERCP in terms of CBD stone resolution without additional morbidity or mortality (16). Others have proposed this same approach specifically in the subset of patients with intermediate risk, with a reported shorter length of stay without increased morbidity (17).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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Background/aims: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL.Methods: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL.Results: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/ sludge. The performance of ASGE high-and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI,.Conclusions: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.

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“…The most updated and comprehensive review of available literature likely was published in 2013 by the Cochrane Group [89] . After a careful and rigorous selection, only 16 RCTs, including a total of 1758 patients, were taken into consideration.…”

Section: Comparing the Different Techniquesmentioning

confidence: 99%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

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Surgical versus endoscopic treatment of bile duct stones

Cited by 242 publications

References 112 publications

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Modern approach to cholecysto-choledocholithiasis

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