Comparison on Two Minimally Invasive Procedures for Gallstones Combined with Common Bile Duct Stones: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Wantao ¹ , WU Zhenhua ² , LI Changen ¹ , JIN Lei ³ ,  YAO Yingmin ¹

1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College of Xi’an Jiao Tong University, Xi’an 710061, China;2. Department of Cerebral Surgery, Affiliated Tumor Hospital XinJiang Medical University, Urumqi 830011, China;3. Department of General Surgery, the Ninth Hospital of Xi’an City, Xi’an 710054, China;

Corresponding author：

YAO Yingmin, Email: YYM8181@yahoo.cn

Keywords：

Gallstones; Common bile duct stones; Laparoscopic common bile duct exploration; Endoscopic retrograde cholangiopancreaticography; Endoscopic sphincterotomy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20110220

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Objective 　To evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis.
Methods 　A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software.
Results　 Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, P lt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges.
Conclusion　 Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.

Citation： LIU Wantao,WU Zhenhua,LI Changen,JIN Lei,YAO Yingmin. Comparison on Two Minimally Invasive Procedures for Gallstones Combined with Common Bile Duct Stones: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2011, 11(11): 1313-1320. doi: 10.7507/1672-2531.20110220 Copy

1.	2 Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc , 2002, 56(6): 165-169.
2.	3 Lacitignola S, Minardi M. Management of common bile duct stones: A ten-year experience at a Tertiary Care Center. JSLS , 2008, 12(1): 62-65.
3.	4 Rogers SJ, Cello JP, Horn JK, et al . Prospective randomized trial of LC+LCBDE vs. ERCP/ S+LC for common bile duct stone disease. Arch Surg , 2010, 45(1): 28-33.
4.	5 Cuschieri A, Croce E, Faggioni A, et al . EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc , 1996, 10(12): 1130-1135.
5.	6 Noble H, Tranter S, Chesworth T, et al . A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A , 2009, 19(6): 713-720.
6.	7 Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chir , 2002, 57(4): 467-474.
7.	8 Cuschieri A, Lezoche E, Morino M, et al . E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc , 1999, 13(10): 952-957.
8.	9 Topal B, Vromman K, Aerts R, et al . Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc , 2010, 24(2): 413-416.
9.	10 Bansal VK, Misra MC, Garg P, et al . A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc , 2010, 24(8): 1986-1989.
10.	18 Heili MJ, Wintz NK, Fowler DL. Choledocholithiasis: endoscopic versus laparoscopic management. Am Surg , 1999, 65(2): 135-138.
11.	19 Memon MA, Hassaballa H, Memon MI. Laparoscopic mommon bile duct exploration: the past, the present, and the future. Am J Surg , 2000, 179(4): 309-315.
12.	20 Yamakawa T, Sakai S, Mu ZB, et al . Laparoscopic management of common bile duct stones. J Hepatobiliary Pancreat Surg , 2000, 7(1): 9-14.
13.	黄志强, 主编. 胆道外科基础与临床. 第1版. 北京: 人民卫生出版社, 2003: 3-7.
14.	周利国, 唐才喜, 周红兵. 腹腔镜内窥镜治疗胆囊结石合并胆总管结石两种术式的临床分析. 中华肝胆外科杂志, 2009, 15(9): 679-681.
15.	沈火剑, 季福. 腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石比较. 临床外科杂志, 2009, 17(8): 522-524.
16.	陈曹臻, 陈春雷, 曾瑜. 腹腔镜胆总管探查取石与EST联合LC治疗胆囊结石并发细径胆总管结石的临床研究. 齐齐哈尔医学院学报, 2009, 30(11): 1285-1286.
17.	彭颖, 王立新, 徐智, 等. 内镜腹腔镜联合与腹腔镜下联合方法治疗胆囊结石合并胆总管结石的临床对照. 中华消化内镜杂志, 2007, 24(5): 342-345.
18.	贺更生, 彭和平, 胡以则. 腹腔镜胆总管探查取石与EST联合LC治疗胆囊疾病合并胆总管结石的临床对比分析. 腹腔镜外科杂志, 2005, 10(2): 88-91.
19.	彭珂, 陈永兵. 胆囊结石合并胆总管结石两种微创方法的比较. 华西医学, 2009, 24(8): 2101-2102.
20.	颜松龄, 吴锦城, 黄孕西, 等. 两种微创术式治疗肝外胆管结石的临床对比分析. 医学信息, 2006, 19(7): 1183-1186.

1. 2 Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc , 2002, 56(6): 165-169.
2. 3 Lacitignola S, Minardi M. Management of common bile duct stones: A ten-year experience at a Tertiary Care Center. JSLS , 2008, 12(1): 62-65.
3. 4 Rogers SJ, Cello JP, Horn JK, et al . Prospective randomized trial of LC+LCBDE vs. ERCP/ S+LC for common bile duct stone disease. Arch Surg , 2010, 45(1): 28-33.
4. 5 Cuschieri A, Croce E, Faggioni A, et al . EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc , 1996, 10(12): 1130-1135.
5. 6 Noble H, Tranter S, Chesworth T, et al . A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A , 2009, 19(6): 713-720.
6. 7 Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chir , 2002, 57(4): 467-474.
7. 8 Cuschieri A, Lezoche E, Morino M, et al . E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc , 1999, 13(10): 952-957.
8. 9 Topal B, Vromman K, Aerts R, et al . Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc , 2010, 24(2): 413-416.
9. 10 Bansal VK, Misra MC, Garg P, et al . A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc , 2010, 24(8): 1986-1989.
10. 18 Heili MJ, Wintz NK, Fowler DL. Choledocholithiasis: endoscopic versus laparoscopic management. Am Surg , 1999, 65(2): 135-138.
11. 19 Memon MA, Hassaballa H, Memon MI. Laparoscopic mommon bile duct exploration: the past, the present, and the future. Am J Surg , 2000, 179(4): 309-315.
12. 20 Yamakawa T, Sakai S, Mu ZB, et al . Laparoscopic management of common bile duct stones. J Hepatobiliary Pancreat Surg , 2000, 7(1): 9-14.
13. 黄志强, 主编. 胆道外科基础与临床. 第1版. 北京: 人民卫生出版社, 2003: 3-7.
14. 周利国, 唐才喜, 周红兵. 腹腔镜内窥镜治疗胆囊结石合并胆总管结石两种术式的临床分析. 中华肝胆外科杂志, 2009, 15(9): 679-681.
15. 沈火剑, 季福. 腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石比较. 临床外科杂志, 2009, 17(8): 522-524.
16. 陈曹臻, 陈春雷, 曾瑜. 腹腔镜胆总管探查取石与EST联合LC治疗胆囊结石并发细径胆总管结石的临床研究. 齐齐哈尔医学院学报, 2009, 30(11): 1285-1286.
17. 彭颖, 王立新, 徐智, 等. 内镜腹腔镜联合与腹腔镜下联合方法治疗胆囊结石合并胆总管结石的临床对照. 中华消化内镜杂志, 2007, 24(5): 342-345.
18. 贺更生, 彭和平, 胡以则. 腹腔镜胆总管探查取石与EST联合LC治疗胆囊疾病合并胆总管结石的临床对比分析. 腹腔镜外科杂志, 2005, 10(2): 88-91.
19. 彭珂, 陈永兵. 胆囊结石合并胆总管结石两种微创方法的比较. 华西医学, 2009, 24(8): 2101-2102.
20. 颜松龄, 吴锦城, 黄孕西, 等. 两种微创术式治疗肝外胆管结石的临床对比分析. 医学信息, 2006, 19(7): 1183-1186.

Chinese Journal of Evidence-Based Medicine

Comparison on Two Minimally Invasive Procedures for Gallstones Combined with Common Bile Duct Stones: A Systematic Review

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