TH4.10 Prophylactic cholecystectomy offers best outcomes following ERCP Clearance of Common Bile Duct stones

Abstract

Aims Clearance of choledocholithiasis reduces recurrent cholangitis, but following clearance of the CBD, cholecystectomy is required. This meta-analysis evaluated outcomes in patients undergoing ERCP with or without sphincterotomy to determine if cholecystectomy post ERCP clearance offers more favourable outcomes than a wait-and-see approach. Methods A Prospero-registered meta-analysis of the literature using PRISMA guidelines incorporating articles relating to ERCP, choledocholithiasis, cholangitis and cholecystectomy was undertaken for papers published between 1st January 1991 and 31st May 2021. Existing research demonstrating outcomes of ERCP with no cholecystectomy versus ERCP and cholecystectomy was reviewed to determine key events, complications, and mortality. Odds Ratios (OR) were calculated using Review Manager Version 5.4 and meta-analyses using OR with either fixed- or random-effect models, depending on heterogeneity of studies. Results 13 studies (n=2,598), published between 2002 and 2019 were included in this meta-analysis: six retrospective studies, two retrospective propensity score matched studies, three prospective studies and two randomised control trials from a total of 11 countries. There were 1,433 in the no cholecystectomy cohort (55.2%) and 1,165 in the prophylactic cholecystectomy cohort (44.8%). 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.