Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ

Abstract

Background: There is no clear consensus on the better therapeutic approach (endoscopic versus surgical) to choledocholithiasis. This study is a meta‐analysis of the available evidence. Methods: A search of the Medline and ISI databases identified 12 studies that met the inclusion criteria for data extraction. The analysis was performed using a random‐effects model. The outcome was calculated as an odds ratio (OR) or relative risk (RR) with 95 per cent confidence intervals (c.i.). Results: Outcomes of 1357 patients were studied. There was no significant difference in successful duct clearance (OR 0·85 (95 per cent c.i. 0·64 to 1·12); P = 0·250), mortality (RR 1·79 (95 per cent c.i. 0·66 to 4·83); P = 0·250), total morbidity (RR 0·89 (95 per cent 0·71 c.i. to 1·13); P = 0·350), major morbidity (RR 1·34 (95 per cent c.i. 0·92 to 1·97); P = 0·130) or need for additional procedures (OR 1·37 (95 per cent c.i. 0·82 to 2·29); P = 0·230) between the endoscopic and surgical groups. There was also no significant difference between the endoscopic and laparoscopic surgery groups. Conclusion: Both approaches have similar outcomes, and treatment should be determined by local resources and expertise. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.